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Splenic vessel preservation versus Warshaw’s technique during spleen-preserving distal pancreatectomy: a meta-analysis and systematic review

  • Systematic Review and Meta-analysis
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

Splenic preservation can be achieved through splenic vessel resection by Warshaw’s technique (WT) or by preserving the splenic vessels. This meta-analysis aims to provide evidence-based comparison regarding the perioperative outcome and long-term benefits between patients with and without splenic vessel preservation (SVP) during spleen-preserving distal pancreatectomy.

Method

A meta-analysis was performed to evaluate studies comparing splenic vessel preservation versus resection groups. Ten retrospective studies including 699 patients were eligible for an analysis of general, perioperative, and long-term outcomes. A further analysis composed of five subgroups was also conducted in terms of laparoscopic approach.

Results

Warshaw’s technique related to significant shorter operation time (P < 0.0001). There was no difference in blood loss (P = 0.45) as well as median tumor size (p = 0.1) between the two groups. The overall rate of complications indicated no difference between SVP and WT (P = 0.1), including pancreatic fistula rates, which were not statistically different among the treatment groups (P = 0.27). However, the occurrence of gastric varices and splenic infarction was significant higher in the WT group (P < 0.01). In laparoscopic subgroups, patients treated by WT had much lower blood loss (P = 0.002).

Conclusion

In spleen-preserving distal pancreatectomy, comparing with SVP, there is no evidence of significant benefit of WT. Nonetheless, surgeons should master both techniques and choose an appropriate one based on personal experience and a “case by case” situation. However, the current available evidence is weak, and further randomized controlled data are warranted.

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Authors’ contributions

Xinzhe Yu performed all the meta-analyses and drafted the manuscript, Hengchao Li carried out the research work, Deliang Fu and Chen Jin performed independent reviews of all studies and data, and Ji Li designed and executed the analysis. Other authors helped review and edit the manuscript. All authors read and approved the final manuscript.

Conflicts of interest and source of funding

The authors reported no conflicts of interest. This work was financially supported by (1) the National Natural Science Foundation of China (81201896 and 81071884) and (2) Research Fund for the Doctoral Program of Higher Education of China (20130071110052).

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    Authors and Affiliations

    1. Pancreatic Surgery Department of Huashan Hospital, Fudan University, Shanghai, 200040, People’s Republic of China

      Xinzhe Yu, Hengchao Li, Chen Jin, Deliang Fu, Yang Di, Sijie Hao & Ji Li

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    1. Xinzhe Yu
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    2. Hengchao Li
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    Correspondence to Ji Li.

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    Study highlights

    • The first meta-analysis to compare splenic vessel preservation (SVP) with the Warshaw’s technique (WT) during spleen-preserving distal pancreatectomy.

    • May represent the largest systematic review of well-designed comparative studies.

    • Orally presented at the 12th Annual Meeting of Japanese Society of Medical Oncology, July 17th–19th, 2014 Fukuoka, Japan.

    Xinzhe Yu and Hengchao Li contributed equally to this work.

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    Yu, X., Li, H., Jin, C. et al. Splenic vessel preservation versus Warshaw’s technique during spleen-preserving distal pancreatectomy: a meta-analysis and systematic review. Langenbecks Arch Surg 400, 183–191 (2015). https://doi.org/10.1007/s00423-015-1273-3

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    • DOI: https://doi.org/10.1007/s00423-015-1273-3

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