Abstract
ObjectiveA distal pancreatectomy has routinely been used for removing benign/borderline malignant tumors of the body and tail of the pancreas; however, controversy exists whether or not the spleen should be saved. Therefore, we conducted this meta-analysis for comparing the clinical outcomes of patients who underwent distal pancreatectomy with or without splenectomy.MethodsA literature research from the databases of Medline, Embase, and Cochrane library was performed to evaluate and compare the clinical outcomes between spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS). Pooled odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (95% CI) were calculated using fixed-effects or random-effects models.ResultsEleven non-randomized controlled studies involving 897 patients were selected to satisfy the inclusion criteria; 355 patients underwent SPDP and 542 patients underwent DPS. Compared with DPS, SPDP required a shorter hospital stay (WMD = 1.16, 95% CI = −2.00 to −0.31, P = 0.007), and had a lower incidence of intra-abdominal abscesses (OR = 0.48, 95% CI = 0.27 to 0.83, P = 0.009). In addition, spleen infarctions occurred in SPDP, most of which involved use of the Warshaw method for preserving the spleen. There were no differences between the SPDP and DPS groups with respect to operative time, operative blood loss, requirement for blood transfusion, pancreatic fistulas, thromboses, post-operative bleeding, wound infections and re-operation rates.ConclusionSPDP should be performed due to the benefits of the immune system and quick post-operative recovery. It is also essential to preserve the splenic artery and vein. Large randomized controlled trials are further needed to verify the results of this meta-analysis.
Highlights
A distal pancreatectomy (DP) is the preferred procedure when resecting benign and borderline malignant tumors of the body and tail of the pancreas
How can one think that the spleen is unimportant in our body and does not put our lives at risk? Through the investigation and follow-up of patients who have undergone splenectomies, poor prognoses are associated with overwhelming post-splenectomy infections (OPSIs), hypercoagulability, and hematologic malignancies [1,2,3]
A comprehensive search was carried out to include all trials that compared the clinical outcomes between Spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS) before September 2013 using the key words in the Medline, Embase, and Cochrane Library electronic databases
Summary
A distal pancreatectomy (DP) is the preferred procedure when resecting benign and borderline malignant tumors of the body and tail of the pancreas. The spleen is usually resected by three methods (laparoscopic, open, or laparoscopic conversion techniques) because it is rather close to the tail of the pancreas. Spleen-preserving distal pancreatectomy (SPDP) has been widely performed since first described by Mallet-Guy and Vachon in 1943 [5]. Warshaw et al [6] introduced the other method of preserving the spleen by saving the short gastric and gastroepiploic vessels. Both techniques are feasible with minimally invasive approaches, which are well-described and safe to perform [6,7]
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