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Comparison of Spleen-Preservation Versus Splenectomy in Minimally Invasive Distal Pancreatectomy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Spleen-preservation during minimally invasive distal pancreatectomy (MIDP) can be technically challenging and remains controversial. Our primary aim was to compare MIDP and splenectomy with spleen-preserving MIDP. Secondarily, we compared two spleen-preserving techniques.

Methods

Adults undergoing MIDP (2007–2021) were retrospectively included in this single-center study. Intraoperative and postoperative outcomes between spleen-preservation and splenectomy and between the two spleen-preserving techniques were compared using the Mann–Whitney U test for continuous data, and Fisher’s exact test for categorical data.

Results

Of the 293 patients who underwent MIDP, preservation of the spleen was intended in 208 (71%) patients. Spleen-preservation was achieved in 174 patients (84%) via the Warshaw technique (130; 75%) or vessel-preservation (44; 25%). The spleen-preserving group had shorter length of stay (3 vs 4 days, p < 0.01), fewer conversions to open (1 vs 12, p < 0.01) and less blood loss (p < 0.01) compared to the splenectomy group. Operative (OR) times were comparable (229 vs 214 min, p = 0.67). Except for the operative time, which was longer for the Warshaw technique (245 vs 183 min, p = 0.01), no other differences between the two spleen-preserving techniques were found. At a median follow-up of 43 (IQR 18–79) months after spleen-preservation, only 2 (1.1%) patients had required splenectomy (1 partial splenectomy for infarct/abscess after Warshaw, 1 for variceal bleeding after vessel-preserving).

Conclusions

Spleen-preservation is not associated with increased risk of blood loss, longer hospital stay, conversion, nor lengthy OR times. Late splenectomy is very rarely required. Given the immune consequences of splenectomy, spleen-preservation should be strongly considered in MIDP.

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Data Availability

The data that support the findings of this study are available from the corresponding author, BCV, upon reasonable request.

Abbreviations

MIDP:

Minimally invasive distal pancreatectomy

OR:

Operative room

SVP:

Splenic vessel preserving

STROBE:

Strengthening the Reporting of Observational studies in Epidemiology

BMI:

Body mass index

ASA:

American Society of Anesthesiologists

PDAC:

Pancreatic ductal adenocarcinoma

WHO:

World Health Organization

EBL:

Estimated blood loss

ERCP:

Endoscopic retrograde cholangiopancreatography

ISGPF:

International Study Group of Pancreatic Fistula

SD:

Standard deviation

IQR:

Interquartile range

OR:

Odds ratio

CI:

Confidence interval

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Funding

This study is investigator-initiated (Stanford Health Care), there was no funding for this research.

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Authors and Affiliations

  1. Department of Surgery, Section of Hepatobiliary Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Hester C. Timmerhuis, Rejoice F. Ngongoni, Jonathan C. DeLong, Monica M. Dua, Jeffrey A. Norton, George A. Poultsides, Patrick J. Worth & Brendan C. Visser

  2. Department of Surgery, Duke University School of Medicine, Durham, NC, USA

    Christopher W. Jensen

  3. Stanford Prevention Research Center and Departments of Statistics and Health Research and Policy, Stanford University, Stanford, CA, USA

    Michael Baiocchi

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  1. Hester C. Timmerhuis
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  2. Rejoice F. Ngongoni
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  3. Christopher W. Jensen
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Contributions

HCT, RFN and CWJ collected and entered all data. HCT, RFN and CWJ verified all entered data. HCT performed the statistical analysis. MB verified the performed statistical analysis. HCT drafted the manuscript. RFN, CWJ, MB, JDL, MD, JN, GP, PW and BV co-authored the writing of the manuscript. All authors critically assessed the study design, included patients in the study, edited the manuscript, and read and approved the final manuscript.

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Correspondence to Brendan C. Visser.

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This work was presented (oral presentation) at the Clinical Congress 2022 of the American College of Surgeons (October 19th, 2022, San Diego, California).

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Timmerhuis, H.C., Ngongoni, R.F., Jensen, C.W. et al. Comparison of Spleen-Preservation Versus Splenectomy in Minimally Invasive Distal Pancreatectomy. J Gastrointest Surg 27, 2166–2176 (2023). https://doi.org/10.1007/s11605-023-05809-3

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