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Splenic Preservation at Distal Pancreatectomy

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Difficult Decisions in Hepatobiliary and Pancreatic Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

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Abstract

There is currently debate as to whether splenic preservation should be attempted during distal pancreatectomy, as splenectomy brings with it the risk of overwhelming post-splenectomy sepsis as well as hematologic aberrations such as thrombocytosis and leukocytosis. Little clarity has been established in understanding the differential benefits and disadvantages of spleen preservation at distal pancreatectomy as compared to those of splenectomy. After review, there are few differences between the two techniques regarding outcomes and postoperative complications. Splenic preservation should be attempted when it is technically feasible and not otherwise contraindicated.

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References

  1. Pandey SK, Bhattacharya S, Mishra RN, Shukla VK. Anatomical variations of the splenic artery and its clinical implications. Clin Anat. 2004;17(6):497–502.

    Article  CAS  PubMed  Google Scholar 

  2. Gwilliam NR, Lazar DA, Brandt ML, Mahoney DH, Wesson DE, Mazziotti MV, Nuchtern JG, Lee TC. An analysis of outcomes and treatment costs for children undergoing splenectomy for chronic immune thrombocytopenia purpura. J Pediatr Surg. 2012;47(8):1537–41.

    Article  PubMed  Google Scholar 

  3. Davies IL, Cho J, Lewis MH. Splenectomy results from an 18-year single centre experience. Ann R Coll Surg Engl. 2014;96(2):147–50.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Holdsworth RJ, Irving AD, Cuschieri A. Postsplenectomy sepsis and its mortality rate: actual versus perceived risks. Br J Surg. 1991;78(9):1031–8.

    Article  CAS  PubMed  Google Scholar 

  5. Warshaw AL. Conservation of the spleen with distal pancreatectomy. Arch Surg. 1988;123(5):550–3.

    Article  CAS  PubMed  Google Scholar 

  6. Scott-Conner CE, Dawson DL. Technical considerations in distal pancreatectomy with splenic preservation. Surg Gynecol Obstet. 1989;168(5):451–2.

    CAS  PubMed  Google Scholar 

  7. Kimura W, Inoue T, Futakawa N, Shinkai H, Han I, Muto T. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Surgery. 1996;120(5):885–90.

    Article  CAS  PubMed  Google Scholar 

  8. Soper NJ, Brunt LM, Dunnegan DL, Meininger TA. Laparoscopic distal pancreatectomy in the porcine model. Surg Endosc. 1994;8(1):57–60; discussion 60–1.

    Article  CAS  PubMed  Google Scholar 

  9. Lee SE, Jang J-Y, Lee KU, Kim S-W. Clinical comparison of distal pancreatectomy with or without splenectomy. J Korean Med Sci. 2008;23(6):1011–4.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tezuka K, Kimura W, Hirai I, Moriya T, Watanabe T, Yano M. Postoperative hematological changes after spleen-preserving distal pancreatectomy with preservation of the splenic artery and vein. Dig Surg. 2012;29(2):157–64.

    Article  PubMed  Google Scholar 

  11. Tsiouris A, Cogan CM, Velanovich V. Distal pancreatectomy with or without splenectomy: comparison of postoperative outcomes and surrogates of splenic function. HPB (Oxf). 2011;13(10):738–44.

    Article  Google Scholar 

  12. Kohan G, Ocampo CG, Zandalazini HI, Klappenbach R, Quesada BM, Porras LTC, Rodriguez JA, Oria AS. Changes in gastrosplenic circulation and splenic function after distal pancreatectomy with spleen preservation and splenic vessel excision. J Gastrointest Surg. 2013;17(10):1739–43.

    Article  PubMed  Google Scholar 

  13. Richardson DQ, Scott-Conner CE. Distal pancreatectomy with and without splenectomy. A comparative study. Am Surg. 1989;55(1):21–5.

    CAS  PubMed  Google Scholar 

  14. Aldridge MC, Williamson RC. Distal pancreatectomy with and without splenectomy. Br J Surg. 1991;78(8):976–9.

    Article  CAS  PubMed  Google Scholar 

  15. Benoist S, Dugué L, Sauvanet A, Valverde A, Mauvais F, Paye F, Farges O, Belghiti J. Is there a role of preservation of the spleen in distal pancreatectomy? J Am Coll Surg. 1999;188(3):255–60.

    Article  CAS  PubMed  Google Scholar 

  16. Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg. 1999;229(5):693–8; discussion 698–700.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Shoup M, Brennan MF, McWhite K, Leung DHY, Klimstra D, Conlon KC. The value of splenic preservation with distal pancreatectomy. Arch Surg. 2002;137(2):164–8.

    Article  PubMed  Google Scholar 

  18. Rodríguez JR, Madanat MG, Healy BC, Thayer SP, Warshaw AL, Fernandez-del CC. Distal pancreatectomy with splenic preservation revisited. Surgery. 2007;141(5):619–25.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kleeff J, Diener MK, Z'graggen K, Hinz U, Wagner M, Bachmann J, Zehetner J, Müller MW, Friess H, Büchler MW. Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg. 2007;245(4):573–82.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Nau P, Melvin WS, Narula VK, Bloomston PM, Ellison EC, Muscarella P. Laparoscopic distal pancreatectomy with splenic conservation: an operation without increased morbidity. Gastroenterol Res Pract. 2009;2009:846340.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Choi SH, Seo MA, Hwang HK, Kang CM, Lee WJ. Is it worthwhile to preserve adult spleen in laparoscopic distal pancreatectomy? Perioperative and patient-reported outcome analysis. Surg Endosc. 2012;26(11):3149–56.

    Article  PubMed  Google Scholar 

  22. Tang CW, Feng WM, Bao Y, Fei MY, Tao YL. Spleen-preserving distal pancreatectomy or distal pancreatectomy with splenectomy?: perioperative and patient-reported outcome analysis. J Clin Gastroenterol. 2014;48(7):e62–6.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Dumitrascu T, Dima S, Stroescu C, Scarlat A, Ionescu M, Popescu I. Clinical value of spleen-preserving distal pancreatectomy: a case-matched analysis with a special emphasis on the postoperative systemic inflammatory response. J Hepatobiliary Pancreat Sci. 2014;21(9):654–62.

    Article  PubMed  Google Scholar 

  24. Butturini G, Inama M, Malleo G, Manfredi R, Melotti GL, Piccoli M, Perandini S, Pederzoli P, Bassi C. Perioperative and long-term results of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessels conservation: a retrospective analysis. J Surg Oncol. 2011;105(4):387–92.

    Article  PubMed  Google Scholar 

  25. Beane JD, Pitt HA, Nakeeb A, Schmidt CM, House MG, Zyromski NJ, Howard TJ, Lillemoe KD. Splenic preserving distal pancreatectomy: does vessel preservation matter? J Am Coll Surg. 2011;212(4):651–7.

    Article  PubMed  Google Scholar 

  26. Adam J-P, Jacquin A, Laurent C, Collet D, Masson B, Fernandez-Cruz L, Sa-Cunha A. Laparoscopic spleen-preserving distal pancreatectomy: splenic vessel preservation compared with the Warshaw technique. JAMA Surg. 2013;148(3):246–52.

    Article  Google Scholar 

  27. Suman P, Rutledge J, Yiengpruksawan A. Robotic distal pancreatectomy. JSLS. 2013;17(4):627–35.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kim SH, Kang CM, Satoi S, Sho M, Nakamura Y, Lee WJ. Proposal for splenectomy-omitting radical distal pancreatectomy in well-selected left-sided pancreatic cancer: multicenter survey study. J Hepatobiliary Pancreat Sci. 2013;20(3):375–81.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 5029, Chicago, IL, 60637, USA

    Benjamin D. Ferguson & Jeffrey B. Matthews

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  1. Benjamin D. Ferguson
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  2. Jeffrey B. Matthews
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Correspondence to Jeffrey B. Matthews .

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Editors and Affiliations

  1. The University of Chicago, CHICAGO, Illinois, USA

    J. Michael Millis

  2. The University of Chicago, CHICAGO, Illinois, USA

    Jeffrey B. Matthews

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Ferguson, B.D., Matthews, J.B. (2016). Splenic Preservation at Distal Pancreatectomy. In: Millis, J., Matthews, J. (eds) Difficult Decisions in Hepatobiliary and Pancreatic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-27365-5_55

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  • DOI: https://doi.org/10.1007/978-3-319-27365-5_55

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27363-1

  • Online ISBN: 978-3-319-27365-5

  • eBook Packages: MedicineMedicine (R0)

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