Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta-analysis

作者：Nakata, Kohei; Shikata, Satoru; Ohtsuka, Takao; Ukai, Tomohiko; Miyasaka, Yoshihiro; Mori, Yasuhisa; Velasquez, Vittoria Vanessa D. M.; Gotoh, Yoshitaka; Ban, Daisuke; Nakamura, Yoshiharu; Nagakawa, Yuichi; Tanabe, Minoru; Sahara, Yatsuka; Takaori, Kyoichi; Honda, Goro; Misawa, Takeyuki; Kawai, Manabu; Yamaue, Hiroki; Morikawa, Takanori; Kuroki, Tamotsu; Mou, Yiping; Lee, Woo-Jung; Shrikhande, Shailesh V.; Tang, Chung Ngai; Conrad, Claudius; Han, Ho-Seong; Chinnusamy, Palanivelu

来源：Journal of Hepato-Biliary-Pancreatic Sciences, 2018, 25(11): 476-488.

DOI：10.1002/jhbp.569

• Laparoscopic distal pancreatectomy
• Spleen
• Vessel preservation
• Warshaw

Background Minimally invasive distal pancreatectomy (MIDP) has gained in popularity recently. However, there is no consensus on whether to preserve the spleen or not. In this study, we compared MIDP outcomes between spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS); as well as outcomes between splenic vessel preservation (SVP) and Warshaw's technique (WT).
Methods A systematic search of PubMed (MEDLINE) and Cochrane Library was conducted and the reference lists of review articles were hand-searched.
Results Fifteen relevant studies with 769 patients were selected for meta-analyses of DPS and SPDP, while another 15 studies with 841 patients were used for the analysis between SVP and WT. Compared with the DPS group, SPDP patients had significantly lower incidences of infectious complications (P = 0.006) and pancreatic fistula (P = 0.002), shorter operative time (P < 0.001), and less blood loss (P = 0.01). Compared with WT, SVP patients had significantly lower incidences of splenic infarction (P < 0.001) and secondary splenectomy (P = 0.003). Subanalysis for laparoscopic surgery alone had similar results.
Conclusions Based on this study, SPDP has significantly superior outcomes compared to DPS. When a spleen is preserved, SVP has better outcomes over WT for reducing splenic complications.

• 出版日期2018-11
• 单位浙江省人民医院