Abstract
Background
Despite the emphasis on its role, the spleen has commonly been removed in distal pancreatectomy. We designed this study to evaluate the efficacy of spleen salvage during laparoscopic distal pancreatectomy for patients with benign and borderline malignant tumors.
Materials and methods
From February 2005 to December 2010, 40 patients underwent spleen-preserving laparoscopic distal pancreatectomy (Sp-Lap DP) and 32 patients underwent laparoscopic distal pancreatosplenectomy (Lap DPS). Medical records were retrospectively reviewed, and a specially designed questionnaire was administered to the patients for the follow-up study.
Results
The demographics and final diagnoses were similar between the two groups. The operative time was significantly longer in the Sp-Lap DP group (303.9 ± 136.0 versus 239.0 ± 94.9 min, p = 0.024). Patients in the Lap DPS group had more postoperative pancreatic fistulas of higher grade (p = 0.026). A higher grade of postoperative complications occurred more frequently in the Lap DPS group (p = 0.003). Consequently, postoperative hospital stay was significantly shorter for Sp-Lap DP than for Lap DPS patients (7.1 ± 2.3 versus 12.5 ± 10.8 days, p = 0.004). On the follow-up survey, episodes of common cold or flu were apparently more frequent in the Lap DPS group (p = 0.026). Despite the similar recovery period between the two groups, significantly more patients who underwent Lap DPS felt fatigue (p = 0.014) and poorer health condition (p = 0.042).
Conclusions
In addition to frequent higher-grade complications and prolonged hospital stays, Lap DPS appeared to impair patient quality of life based on follow-up survey. Even an effort to preserve adult spleen in distal pancreatectomy is worthwhile.
Similar content being viewed by others
References
Waghorn DJ (2001) Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. J Clin Pathol 54:214–218
Hansen K, Singer DB (2001) Asplenic-hyposplenic overwhelming sepsis: postsplenectomy sepsis revisited. Pediatr Dev Pathol 4:105–121
McGory ML, Zingmond DS, Sekeris E, Ko CY (2007) The significance of inadvertent splenectomy during colorectal cancer resection. Arch Surg 142:668–674
Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT et al (1995) Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 345:745–748
Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V et al (1999) Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer 79:1522–1530
Aminian A, Mirsharifi R, Karimian F, Khorgami Z, Nasiri S, Yazdankhah-Konari A et al (2010) Influence of splenectomy on morbidity of esophageal cancer surgery. Scand J Surg 99:9–13
Mellemkjoer L, Olsen JH, Linet MS, Gridley G, McLaughlin JK (1995) Cancer risk after splenectomy. Cancer 75:577–583
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ et al (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25
Shoup M, Brennan MF, McWhite K, Leung DH, Klimstra D, Conlon KC (2002) The value of splenic preservation with distal pancreatectomy. Arch Surg 137:164–168
Jones P, Leder K, Woolley I, Cameron P, Cheng A, Spelman D (2010) Postsplenectomy infection—strategies for prevention in general practice. Aust Fam Physician 39:383–386
Kang CM, Kim DH, Lee WJ, Chi HS (2011) Conventional laparoscopic and robot-assisted spleen-preserving pancreatectomy: does da Vinci have clinical advantages? Surg Endosc 25:2004–2009
Choi SH, Kang CM, Lee WJ, Chi HS (2011) robot-assisted spleen-preserving laparoscopic distal pancreatectomy. Ann Surg Oncol
Giulianotti PC, Sbrana F, Bianco FM, Elli EF, Shah G, Addeo P et al (2010) Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc 24:1646–1657
Waters JA, Canal DF, Wiebke EA, Dumas RP, Beane JD, Aguilar-Saavedra JR et al (2010) Robotic distal pancreatectomy: cost effective? Surgery 148:814–823
Benoist S, Dugue L, Sauvanet A, Valverde A, Mauvais F, Paye F et al (1999) Is there a role of preservation of the spleen in distal pancreatectomy? J Am Coll Surg 188:255–260
Warshaw AL (2010) Distal pancreatectomy with preservation of the spleen. J Hepatobiliary Pancreat Sci 17:808–812
Warshaw AL (1988) Conservation of the spleen with distal pancreatectomy. Arch Surg 123:550–553
Rodriguez JR, Madanat MG, Healy BC, Thayer SP, Warshaw AL, Fernandez-del Castillo C (2007) Distal pancreatectomy with splenic preservation revisited. Surgery 141:619–625
Beane JD, Pitt HA, Nakeeb A, Schmidt CM, House MG, Zyromski NJ et al (2011) Splenic preserving distal pancreatectomy: does vessel preservation matter? J Am Coll Surg 212:651–657; discussion 7–8
Okabayashi T, Hanazaki K (2008) Overwhelming postsplenectomy infection syndrome in adults—a clinically preventable disease. World J Gastroenterol 14:176–179
Disclosure
Authors Sung Hoon Choi, Mi Ae Seo, Ho Kyoung Hwang, Chang Moo Kang, and Woo Jung Lee have no conflicts of interest or source of funding to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Choi, S.H., Seo, M.A., Hwang, H.K. et al. Is it worthwhile to preserve adult spleen in laparoscopic distal pancreatectomy? Perioperative and patient-reported outcome analysis. Surg Endosc 26, 3149–3156 (2012). https://doi.org/10.1007/s00464-012-2306-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-012-2306-4