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Laparoscopic Spleen-Preserving Distal Pancreatectomy: Comparative Study of Spleen Preservation with Splenic Vessel Resection and Splenic Vessel Preservation

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Abstract

Background

Spleen-preserving laparoscopic distal pancreatectomy (SPLDP) can be performed with splenic vessel resection (SVR) or splenic vessel preservation (SVP). The purpose of this comparative study was to evaluate the clinical outcomes of patients who underwent SPLDP with SVR or SVP at a single institution.

Methods

We retrospectively reviewed the records of 246 patients who underwent SPLDP at Asan Medical Center, Seoul, Korea, for benign or low-grade malignant tumors found in the body or tail of the pancreas between November 2005 and November 2011.

Results

In total, 206 patients (83.7 %) were managed by SVP. SVR was performed in the remaining 40 (16.3 %) cases. There were no significant differences between the SVP and SVR groups in terms of intraoperative blood loss (378 ± 240 vs. 328 ± 204 ml, respectively; P = 0.240) and operating time (193.4 ± 59.1 vs. 204.4 ± 51.8 min, respectively; P = 0.492). Sixty-seven (32.5 %) and 10 patients (25 %) had complications in the SVP and SVR groups, respectively (P = 0.347). At 3 days after surgery, the rates of splenic infarction were 16.0 % (33/206) in the SVP group and 52.5 % (21/40) in the SVR group, but all recovered within 12 months on postoperative computed tomography. The time of recovery from splenic infarction was 3.6 ± 3.1 and 4.7 ± 3.7 months in the SVP and SVR groups, respectively. At 6 months, the rates of gastric varices were 1.9 % in the SVP group and 35 % in the SVR group (P < 0.001) with no progression at 12 months. No gastrointestinal bleeding occurred at a median follow-up of 34 months (range = 12–84).

Conclusions

SPLDP with SVR can be used for patients with large and benign or low-grade malignant tumors that distort and compress vessel course, as the higher rate of early splenic ischemia and perigastric varices is acceptable.

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References

  1. Warshaw AL (1988) Conservation of the spleen with distal pancreatectomy. Arch Surg 123:550–553

    Article  PubMed  CAS  Google Scholar 

  2. Warshaw AL (2010) Distal pancreatectomy with preservation of the spleen. J Hepato-biliary Pancreat Sci 17:808–812

    Article  Google Scholar 

  3. Butturini G, Inama M, Malleo G et al (2012) Perioperative and long-term results of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessels conservation: a retrospective analysis. J Surg Oncol 105:387–392

    Article  PubMed  Google Scholar 

  4. Casadei R, Ricci C, D’Ambra M et al (2010) Laparoscopic versus open distal pancreatectomy in pancreatic tumours: a case–control study. Updates Surg 62:171–174

    Article  PubMed  Google Scholar 

  5. Mehta SS, Doumane G, Mura T et al (2012) Laparoscopic versus open distal pancreatectomy: a single-institution case–control study. Surg Endosc 26:402–407

    Article  PubMed  Google Scholar 

  6. Song KB, Kim SC, Park JB et al (2011) Single-center experience of laparoscopic left pancreatic resection in 359 consecutive patients: changing the surgical paradigm of left pancreatic resection. Surg Endosc 25:3364–3372

    Article  PubMed  Google Scholar 

  7. Miura F, Takada T, Asano T et al (2005) Hemodynamic changes of splenogastric circulation after spleen-preserving pancreatectomy with excision of splenic artery and vein. Surgery 138:518–522

    Article  PubMed  Google Scholar 

  8. Fernandez-Cruz L, Martinez I, Gilabert R et al (2004) Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg 8:493–501

    Article  PubMed  Google Scholar 

  9. Kim SC, Park KT, Hwang JW et al (2008) Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc 22:2261–2268

    Article  PubMed  Google Scholar 

  10. Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–526

    PubMed  CAS  Google Scholar 

  11. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sarr MG, Pancreatic Surgery Group (2003) The potent somatostatin analogue vapreotide does not decrease pancreas-specific complications after elective pancreatectomy: a prospective, multicenter, double-blinded, randomized, placebo-controlled trial. J Am Coll Surg 196:556–564 (discussion 564–555; author reply 565)

    Article  PubMed  Google Scholar 

  13. Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  14. Butturini G, Daskalaki D, Molinari E et al (2008) Pancreatic fistula: definition and current problems. J Hepato-biliary Pancreat Surg 15:247–251

    Article  Google Scholar 

  15. Yoon YS, Lee KH, Han HS et al (2009) Patency of splenic vessels after laparoscopic spleen and splenic vessel-preserving distal pancreatectomy. Br J Surg 96:633–640

    Article  PubMed  Google Scholar 

  16. Coelho-Prabhu N, Kamath PS (2010) Current staging and diagnosis of gastroesophageal varices. Clin Liver Dis 14:195–208

    Article  PubMed  Google Scholar 

  17. Sarin SK, Lahoti D, Saxena SP et al (1992) Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 16:1343–1349

    Article  PubMed  CAS  Google Scholar 

  18. Soper NJ, Soper NJ, Dunnegan DL et al (1994) Laparoscopic distal pancreatectomy in the porcine model. Surg Endosc 8:57–60 (discussion 60–51)

    Article  PubMed  CAS  Google Scholar 

  19. Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120:1051–1054

    Article  PubMed  CAS  Google Scholar 

  20. Vezakis A, Davides D, Larvin M et al (1999) Laparoscopic surgery combined with preservation of the spleen for distal pancreatic tumors. Surg Endosc 13:26–29

    Article  PubMed  CAS  Google Scholar 

  21. Jean-Philippe A, Alexandre J, Christophe L et al (2013) Laparoscopic spleen-preserving distal pancreatectomy: splenic vessel preservation compared with the Warshaw technique. JAMA Surg 148:246–252

    Article  Google Scholar 

  22. Carrere N, Abid S, Julio CH, Julio CH et al (2007) Spleen-preserving distal pancreatectomy with excision of splenic artery and vein: a case-matched comparison with conventional distal pancreatectomy with splenectomy. World J Surg 31:375–382. doi:10.1007/s00464-012-2605-9

    Article  PubMed  Google Scholar 

  23. Sato Y, Shimoda S, Takeda N et al (2000) Evaluation of splenic circulation after spleen-preserving distal pancreatectomy by dividing the splenic artery and vein. Dig Surg 17:519–522

    Article  PubMed  CAS  Google Scholar 

  24. Miura F, Takada T, Asano T et al (2004) Gastric varices occurring after middle-segment pancreatectomy preserving spleen with division of splenic artery and vein. Surgery 135:696–697

    Article  PubMed  Google Scholar 

  25. Miura F, Sano K, Amano H et al (2011) Is spleen-preserving distal pancreatectomy with excision of the splenic artery and vein feasible? Surgery 150:572

    Article  PubMed  Google Scholar 

  26. Tien YW, Liu KL, Hu RH et al (2010) Risk of varices bleeding after spleen-preserving distal pancreatectomy with excision of splenic artery and vein. Ann Surg Oncol 17:2193–2198

    Article  PubMed  Google Scholar 

  27. Hashizume M, Kitano S, Yamaga H et al (1990) Endoscopic classification of gastric varices. Gastrointest Endosc 36:276–280

    Article  PubMed  CAS  Google Scholar 

  28. Kim T, Shijo H, Kokawa H et al (1997) Risk factors for hemorrhage from gastric fundal varices. Hepatology 25:307–312

    Article  PubMed  CAS  Google Scholar 

  29. Hashizume M, Akahoshi T, Tomikawa M (2011) Management of gastric varices. J Gastroenterol Hepatol 26(Suppl 1):102–108

    Article  PubMed  Google Scholar 

  30. Irani S, Kowdley K, Kozarek R (2011) Gastric varices: an updated review of management. J Clin Gastroenterol 45:133–148

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China

    Zun Qiang Zhou

  2. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Ulsan University, College of Medicine and Asan Medical Center, 86, Asan byeongwon-gil, Songpa-gu, Seoul, 138-736, Korea

    Zun Qiang Zhou, Song Cheol Kim, Ki Byung Song, Kwang-Min Park, Jae Hoon Lee & Young-Joo Lee

Authors
  1. Zun Qiang Zhou
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  2. Song Cheol Kim
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  3. Ki Byung Song
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  4. Kwang-Min Park
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  5. Jae Hoon Lee
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  6. Young-Joo Lee
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Correspondence to Song Cheol Kim.

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Zhou, Z.Q., Kim, S.C., Song, K.B. et al. Laparoscopic Spleen-Preserving Distal Pancreatectomy: Comparative Study of Spleen Preservation with Splenic Vessel Resection and Splenic Vessel Preservation. World J Surg 38, 2973–2979 (2014). https://doi.org/10.1007/s00268-014-2671-3

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  • DOI: https://doi.org/10.1007/s00268-014-2671-3

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