Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study

Moekotte, Alma; Lof, Sanne; White, Steve; Marudanayagam, R.; Al-Sarireh, Bilal; Rahman, Sakhanat; Soonawalla, Zahir; Deakin, Mark; Aroori, Somaiah; Ammori, Basil J.; Gomez, Dhanny; Marangoni, Gabriele; Hilal, Mohammed Abu

doi:10.1007/s00464-019-06901-z

Cited by 26 publications

(25 citation statements)

References 32 publications

(40 reference statements)

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“…Moekotte et al [10] performed 87 cases of LSPDP for PNENs with feasible short-term outcome. However, there study also included 142 cases of LSPDP for pathologies other than PNENs and without long-term outcome [10]. To the best of our knowledge, this study was just focused on laparoscopic organ-sparing resection for PNENs.…”

Section: Discussionmentioning

confidence: 99%

Short‐ and Long‐Term Outcomes of Laparoscopic Organ‐Sparing Resection for Pancreatic Neuroendocrine Neoplasms

Zhang¹,

Ma²,

Mou

et al. 2020

World j. surg.

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Background Pancreatic neuroendocrine neoplasms (PNENs) are rare neoplasm with long life expectancy. In this setting, patients may benefit from laparoscopic organ-sparing resection. There are few reports of laparoscopic organ-sparing resection for PNENs. The aim of this study was to evaluate the Short-and long-term outcomes of laparoscopic organ-sparing resection for PNENs. Methods A retrospective study was performed for patients with PNENs who underwent laparoscopic organsparing pancreatectomy between March 2005 and May 2018. The patients' demographic data, operative results, pathological reports, hospital courses, morbidity and mortality, and follow-up data (including pancreatic function, till August 2018) was analyzed. Results Thirty-five patients were identified. There were 9 male and 26 female patients, with a median age of 46 years (range, 25-75 years). The mean BMI was 24.6±3.3kg/m 2. Nine patients received laparoscopic enucleation, 20 received laparoscopic spleen-preserving distal pancreatectomy, and 6 received laparoscopic central pancreatectomy. The operative time, intraoperative blood loss, transfusion rate, postoperative hospital stay were 186.4±60.2min, 165±73.0ml, 0, 9d(range, 5-23d), respectively. The morbidity rate, ≥Grade Ⅲ complication rate and ≥grade B pancreatic fistula rate were 34.2%, 11.4%, 8.7%, respectively, with no mortality. The rate of follow-up was 94.3%, and the median follow-up time was 55 months (range, 3-158months). One patients had diabetes after laparoscopic spleen-preserving distal pancreatectomy, no patient had symptom of pancreatic exocrine insufficiency. One patient developed recurrence 36 months after laparoscopic enucleation and was managed with surgical resection. The other patients survived without metastases or recurrence during the follow-up. Conclusions Laparoscopic organ-sparing resection for selected cases of PNENs is safe and feasible, and have favorable short-and long-term outcome.

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Section: Discussionmentioning

confidence: 99%

Short‐ and Long‐Term Outcomes of Laparoscopic Organ‐Sparing Resection for Pancreatic Neuroendocrine Neoplasms

Zhang¹,

Ma²,

Mou

et al. 2020

World j. surg.

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“…Исторически дистальная субтотальная резекция (ДСР) поджелудочной железы (ПЖ) почти всегда сопровождалась спленэктомией (СЭ), что обусловлено анатомической близостью и общим кровоснабжением этих органов. При злокачественной природе первичных опухолей тела и (или) хвоста ПЖ лимфатические узлы ворот селезенки являются регионарным коллектором лимфогенного метастазирования, что обязывает к удалению селезенки по онкологическим показаниям [1][2][3]. Однако селезенка -перифери ческий лимфоидный орган иммунной системы.…”

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Immediate results of spleen-preserving distal subtotal pancreatic resection

et al. 2021

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Aim. To assess the possibility of open spleen-preserving distal subtotal pancreatic resection for tumors of the body and tail of the pancreas.Material and methods. A retrospective comparative analysis of the immediate results of the spleen-preserving interventions in 41 patients was carried out. Mainly benign tumors or tumors with a low malignancy potential of the corpus and (or) the tail of the pancreas were detected. Distal subtotal pancreatectomy with splenectomy was performed in 53 patients with pancreatic tumors of different histogenesis with low malignancy potential (control group).Results. The duration of spleen-preserving distal subtotal pancreatectomy was 12 minutes shorter, compared with the distal subtotal pancreatectomy with splenectomy group (p = 0.180). Significantly lower volume of intraoperative blood loss during spleen-preserving procedure was noted – by 460 ml (p = 0.0001). The level of postoperative complications in the spleen-preserving pancreatectomy group was 15 (37%), while in the group of distal subtotal pancreatectomy with splenectomy was 26 (49%) (p = 0.227), respectively. External pancreatic fistula after spleenpreserving pancreatectomy was noted in 13 (32%) patients, in the other group in 21 (40%; p = 0.429). The duration of hospital stay did not statistically significantly differ in the compared groups and amounted to: 18.6 ± 6.9 and 20.3 ± 5.4 days (p = 0.123), respectively.Conclusion. Open spleen-preserving pancreatectomy is a relatively safe type of surgical treatment for patients with benign tumors and tumors with a low potential for malignancy of the body and/or tail of the pancreas. The surgery is shorter in time, accompanied by a lower level of complications, significantly less intraoperative blood loss, compared with a similar procedure involving splenectomy.

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“…Previous studies indicate that splenectomy is associated with several complications during follow-up, such as infections, thromboembolism, and increased risk of developing cancer [ 6 – 8 ]. Many pancreatic surgeons further compared the clinical outcomes between patients who received distal pancreatectomy with splenectomy (DPS) and SPDP, and the results showed that the SPDP group may present fewer infection complications, less operative blood loss, and a lower overall morbidity rate [ 9 , 10 ]. To understand the mechanisms of the above aberrations, several studies have examined hematologic and immunological changes after splenectomy, presenting thrombocytosis, leukocytosis, decreased immunoglobulin M production, and depressed phagocytic activity [ 11 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Dynamic hematological changes in patients undergoing distal pancreatectomy with or without splenectomy: a population-based cohort study

et al. 2020

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Background The clinical outcomes of patients who received distal pancreatectomy with splenectomy (DPS) and spleen-preserving distal pancreatectomy (SPDP) have been generally investigated. However, postoperative hematological changes after distal pancreatectomy with or without splenectomy are poorly understood. Methods Information from patients undergoing distal pancreatectomy (DP) between January 2014 and June 2019 at a single institution was reviewed. A linear mixed-effects model was used to compare dynamic hematological changes between different groups. Results A total of 302 patients who underwent DP were enrolled. In the long term, most postoperative hematological parameters remained significantly higher than preoperative levels in the DPS group, while postoperative lymphocyte, monocyte, basophil, and platelet levels returned to preoperative levels in the SPDP group. All postoperative hematological parameters except for red blood cell count and serum hemoglobulin level were significantly higher in the DPS group than in the SPDP group. There were no significant differences in hematological changes between the splenic vessel preservation (SVP) and Warshaw technique (WT) groups. Conclusions Postoperative hematological changes were significantly different between the DPS and SPDP groups. Compared to DPS, SPDP reduced abnormal hematological changes caused by splenectomy. SVP and WT were comparable in terms of postoperative hematological changes.

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Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study

Cited by 26 publications

References 32 publications

Short‐ and Long‐Term Outcomes of Laparoscopic Organ‐Sparing Resection for Pancreatic Neuroendocrine Neoplasms

Short‐ and Long‐Term Outcomes of Laparoscopic Organ‐Sparing Resection for Pancreatic Neuroendocrine Neoplasms

Immediate results of spleen-preserving distal subtotal pancreatic resection

Dynamic hematological changes in patients undergoing distal pancreatectomy with or without splenectomy: a population-based cohort study

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