World Journal of Surgery

, Volume 31, Issue 2, pp 375–382 | Cite as

Spleen-preserving Distal Pancreatectomy with Excision of Splenic Artery and Vein: A Case-matched Comparison with Conventional Distal Pancreatectomy with Splenectomy

  • Nicolas Carrère
  • Skander Abid
  • Charles Henri Julio
  • Eric Bloom
  • Bernard Pradère
Article

Abstract

Background

The value of spleen preservation during distal pancreatectomy (DP) still remains controversial. Spleen-preserving DP with excision of the splenic artery and vein is a simplified technique for spleen preservation. The aim of this study was to compare the postoperative course of DP with or without splenectomy.

Patients and Methods

From 1990 to 2005, 38 consecutive patients with benign or low-grade malignant disease underwent a spleen-preserving DP operation with excision of the splenic artery and vein (Conservative Group). They were compared with 38 patients who underwent conventional DP with splenectomy over the same time period (Splenectomy Group) and who had been matched for age, American Society of Anesthesiologists (ASA) score, and pathological diagnosis. Postoperative courses were analyzed and compared between the Conservative Group and Splenectomy Group.

Results

Spleen preservation was effective in 36 of the 38 attempts (95%). Postoperative complications – in particular, infectious intra-abdominal complications – were significantly higher in the Splenectomy Group (34 and 18%, respectively) than in the Conservative Group (13 and 3%, respectively) (P = 0.03 and P = 0.02, respectively). The length of the surgery, perioperative blood loss or transfusions, perioperative mortality and length of hospital stay did not differ between the two groups. Univariate analysis showed that splenectomy was the only risk factor for postoperative complication.

Conclusions

Spleen-preserving DP with excision of the splenic artery and vein is a fast, safe and effective procedure associated, in this series, with a reduction of postoperative complications relative to conventional DP with splenectomy. This technique should be considered in patients with benign or low-grade malignant disease of the pancreas.

Abbreviations:

DP

Distal pancreatectomy

SPDP

Spleen-preserving distal pancreatectomy

ASA

American Society of Anesthesiologists

References

  1. 1.
    Lillemoe KD, Kaushal S, Cameron JL, et al. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 1999;229:693–698PubMedCrossRefGoogle Scholar
  2. 2.
    Balcom JHt, Rattner DW, Warshaw AL, et al. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 2001;136:391–398PubMedCrossRefGoogle Scholar
  3. 3.
    Cullingford GL, Watkins DN, Watts AD, et al. Severe late postsplenectomy infection. Br J Surg 1991;78:716–721PubMedGoogle Scholar
  4. 4.
    Mellesmkjoer L, Olsen JH, Linet MS, et al. Cancer risk after splenectomy. Cancer 1995;75:577–583CrossRefGoogle Scholar
  5. 5.
    Richardson DQ, Scott-Conner CE. Distal pancreatectomy with and without splenectomy. A comparative study. Am Surg 1989;55:21–25PubMedGoogle Scholar
  6. 6.
    Aldridge MC, Williamson RC. Distal pancreatectomy with and without splenectomy. Br J Surg 1991;78:976–979PubMedGoogle Scholar
  7. 7.
    Benoist S, Dugue L, Sauvanet A, et al. Is there a role of preservation of the spleen in distal pancreatectomy? J Am Coll Surg 1999;188:255–260PubMedCrossRefGoogle Scholar
  8. 8.
    Shoup M, Brennan MF, McWhite K, et al. The value of splenic preservation with distal pancreatectomy. Arch Surg 2002;137:164–168PubMedCrossRefGoogle Scholar
  9. 9.
    Warshaw AL. Conservation of the spleen with distal pancreatectomy. Arch Surg 1988;123:550–553PubMedGoogle Scholar
  10. 10.
    Miettinen OS. Individual matching with multiple controls in the case of all-or-none responses. Biometrics 1969;25:339–355PubMedCrossRefGoogle Scholar
  11. 11.
    Mallet-Guy P, Vachon A. Pancreatites chroniques gauches. Masson, Paris, 1943Google Scholar
  12. 12.
    Kimura W, Inoue T, Futakawa N, et al. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Surgery 1996;120:885–890PubMedCrossRefGoogle Scholar
  13. 13.
    Sato Y, Shimoda S, Takeda N, et al. Evaluation of splenic circulation after spleen-preserving distal pancreatectomy by dividing the splenic artery and vein. Dig Surg 2000;17:519–522PubMedCrossRefGoogle Scholar
  14. 14.
    Pradere B, Julio CH, Rimailho J, et al. Left pancreatectomy with preservation of the spleen without its pedicle. A propos of 13 cases. Ann Chir 1992;46:620–624PubMedGoogle Scholar
  15. 15.
    White SA, Sutton CD, Weymss-Holden S, et al. The feasibility of spleen-preserving pancreatectomy for end-stage chronic pancreatitis. Am J Surg 2000;179:294–297PubMedCrossRefGoogle Scholar
  16. 16.
    Vezakis A, Davides D, Larvin M, et al. Laparoscopic surgery combined with preservation of the spleen for distal pancreatic tumors. Surg Endosc 1999;13:26–29PubMedCrossRefGoogle Scholar
  17. 17.
    Tagaya N, Ishikawa K, Kubota K. Spleen-preserving laparoscopic distal pancreatectomy with conservation of the splenic artery and vein for a large insulinoma. Surg Endosc 2002;16:217–218PubMedGoogle Scholar
  18. 18.
    Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med 1999;340:908–914PubMedCrossRefGoogle Scholar
  19. 19.
    Varty PP, Linehan IP, Boulos PB. Does concurrent splenectomy at colorectal cancer resection influence survival? Dis Colon Rectum 1993;36:602–606PubMedCrossRefGoogle Scholar
  20. 20.
    Billiar TR, West MA, Hyland BJ, et al. Splenectomy alters Kupffer cell response to endotoxin. Arch Surg 1988;123:327–332PubMedGoogle Scholar
  21. 21.
    Wolf HM, Eibl MM, Georgi E, et al. Long-term decrease of CD4 + CD45RA+ T cells and impaired primary immune response after post-traumatic splenectomy. Br J Haematol 1999;107:55–68PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Nicolas Carrère
    • 1
    • 2
  • Skander Abid
    • 1
  • Charles Henri Julio
    • 1
  • Eric Bloom
    • 1
  • Bernard Pradère
    • 1
  1. 1.Department of Digestive Surgery (Pr Pradère)Purpan University HospitalToulouseFrance
  2. 2.Service de Chirurgie DigestiveHôpital PurpanToulouse CedexFrance

Personalised recommendations