Abstract
BackgroundThe laparoscopic approach in distal pancreatectomy is associated with higher rates of splenic preservation compared to open surgery. Although favorable postoperative short-term outcomes have been reported in open spleen-preserving distal pancreatectomy when compared to distal pancreatectomy with splenectomy, it is unclear whether this observation applies to the laparoscopic approach. The aim of this study is to compare laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with laparoscopic distal pancreatectomy with splenectomy (LDPS).Study designThis is a UK wide, propensity score-matched study, including patients who underwent LSPDP or LDPS between 2006 and 2016. Short-term outcomes were compared between LSPDP and LDPS according to intention to treat. Additionally, risk factors for unplanned splenectomy were explored.ResultsA total of 456 patients were included from eleven centers (229 LSPDP and 227 LDPS). We were able to match 173 LSPDP cases to 173 LDPS cases, according to intention to treat. No differences were seen in postoperative morbidity between the groups. The only identified risk factor for unplanned splenectomy was tumor size ≥ 30 mm.ConclusionsPreserving the spleen during laparoscopic distal pancreatectomy is not associated with a lower postoperative morbidity compared to sacrificing the spleen. Tumor size is a risk factor for unplanned splenectomy.
Highlights
The laparoscopic approach in distal pancreatectomy is associated with higher rates of splenic preservation compared to open surgery
laparoscopic spleen-preserving distal pancreatectomy (LSPDP) was attempted in 229 patients, in whom splenic preservation was achieved in 184 (80%), some 45 (20%) were converted to laparoscopic distal pancreatectomy with splenectomy (LDPS)
The current study showed that a smaller proportion of patients received a postoperative blood transfusion after LSPDP than after LDPS, even though, estimated blood loss (EBL) was comparable in both groups (150 ml vs. 200 ml in LSPDP and LDPS, respectively)
Summary
The laparoscopic approach in distal pancreatectomy is associated with higher rates of splenic preservation compared to open surgery. Favorable postoperative short-term outcomes have been reported in open spleen-preserving distal pancreatectomy when compared to distal pancreatectomy with splenectomy, it is unclear whether this observation applies to the laparoscopic approach. The aim of this study is to compare laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with laparoscopic distal pancreatectomy with splenectomy (LDPS). Short-term outcomes were compared between LSPDP and LDPS according to intention to treat. The only identified risk factor for unplanned splenectomy was tumor size ≥ 30 mm. Conclusions Preserving the spleen during laparoscopic distal pancreatectomy is not associated with a lower postoperative morbidity compared to sacrificing the spleen. Tumor size is a risk factor for unplanned splenectomy
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