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Lee O, Yoon SK, Yoon SJ, Kim H, Han IW, Heo JS, Shin SH. Fate of small remnant pancreatic tail in splenic hilum after laparoscopic spleen preserving distal pancreatectomy: a retrospective study. Ann Surg Treat Res 2024; 106:211-217. [PMID: 38586554 PMCID: PMC10995840 DOI: 10.4174/astr.2024.106.4.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose When performing laparoscopic spleen-preserving distal pancreatectomy (LSPDP), sometimes, anatomically challenging patients are encountered, where the pancreatic tail is deep in the splenic hilum. The purpose of this study was to discuss the experience with the surgical technique of leaving the deep pancreatic tail of the splenic hilum in these patients. Methods Eleven patients who underwent LSPDP with remnant pancreatic tails between November 2019 and August 2021 at Samsung Medical Center in Seoul, Korea were included in the study. Their short-term postoperative outcomes were analyzed retrospectively. Results The mean operative time was 168.6 ± 26.0 minutes, the estimated blood loss was 172.7 ± 95.8 mL, and the postoperative length of stay was 6.1 ± 1.0 days. All 11 lesions were in the body or tail of the pancreas and included 2 intraductal papillary mucinous neoplasms, 6 neuroendocrine tumors, 2 cystic neoplasms, and 1 patient with chronic pancreatitis. In 10 of the 11 patients, only the pancreatic tail was left inside the distal portion of the splenic hilum of the branching splenic vessel, and there was a collection of intraabdominal fluid, which was naturally resolved. One patient with a remnant pancreatic tail above the hilar vessels was readmitted due to a postoperative pancreatic fistula with fever and underwent internal drainage. Conclusion In spleen preservation, leaving a small pancreatic tail inside the splenic hilum is feasible and more beneficial to the patient than performing splenectomy in anatomically challenging patients.
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Affiliation(s)
- Okjoo Lee
- Division of Hepatobiliary-pancreatic Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - So Kyung Yoon
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - So Jeong Yoon
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hongbeom Kim
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Woong Han
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Hyun Shin
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Wei J, Ou Y, Chen J, Yu Z, Wang Z, Wang K, Yang D, Gao Y, Liu Y, Liu J, Zheng X. Mapping global new-onset, worsening, and resolution of diabetes following partial pancreatectomy: a systematic review and meta-analysis. Int J Surg 2024; 110:1770-1780. [PMID: 38126341 PMCID: PMC10942179 DOI: 10.1097/js9.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND AIMS Partial pancreatectomy, commonly used for chronic pancreatitis, or pancreatic lesions, has diverse impacts on endocrine and metabolism system. The study aims to determine the global prevalence of new-onset, worsening, and resolution of diabetes following partial pancreatectomy. METHODS The authors searched PubMed, Embase, Web of Science, and Cochrane Library from inception to October, 2023. DerSimonian-Laird random-effects model with Logit transformation was used. Sensitivity analysis, meta-regression, and subgroup analysis were employed to investigate determinants of the prevalence of new-onset diabetes. RESULTS A total of 82 studies involving 13 257 patients were included. The overall prevalence of new-onset diabetes after partial pancreatectomy was 17.1%. Univariate meta-regression indicated that study size was the cause of heterogeneity. Multivariable analysis suggested that income of country or area had the highest predictor importance (49.7%). For subgroup analysis, the prevalence of new-onset diabetes varied from 7.6% (France, 95% CI: 4.3-13.0) to 38.0% (UK, 95% CI: 28.2-48.8, P <0.01) across different countries. Patients with surgical indications for chronic pancreatitis exhibited a higher prevalence (30.7%, 95% CI: 21.8-41.3) than those with pancreatic lesions (16.4%, 95% CI: 14.3-18.7, P <0.01). The type of surgical procedure also influenced the prevalence, with distal pancreatectomy having the highest prevalence (23.7%, 95% CI: 22.2-25.3, P <0.01). Moreover, the prevalence of worsening and resolution of preoperative diabetes was 41.1 and 25.8%, respectively. CONCLUSIONS Postoperative diabetes has a relatively high prevalence in patients undergoing partial pancreatectomy, which calls for attention and dedicated action from primary care physicians, specialists, and health policy makers alike.
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Affiliation(s)
- Junlun Wei
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research
| | - Yiran Ou
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research
| | - Jiaoting Chen
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research
| | - Zhicheng Yu
- Department of Economics, Keio University, Minato city, Tokyo, Japan
| | - Zhenghao Wang
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research
| | - Ke Wang
- Department of Vascular Surgery, University Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Dujiang Yang
- Department of General Surgery, Division of Pancreatic Surgery, West China Hospital, Sichuan University
| | - Yun Gao
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research
| | - Yong Liu
- Department of General Surgery, Division of Pancreatic Surgery, West China Hospital, Sichuan University
| | - Jiaye Liu
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-Related Molecular Network, Center of Precision Medicine, Precision Medicine Key Laboratory of Sichuan Province
- Laboratory of Thyroid and Parathyroid diseases, Frontiers Science Center for Disease-Related Molecular Network
- Department of General Surgery, Division of Thyroid Surgery, West China Hospital, Sichuan University
| | - Xiaofeng Zheng
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research
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Gorris M, van Bodegraven EA, Abu Hilal M, Bolm L, Busch OR, del Chiaro M, Habib J, Hasegawa K, He J, van Hooft JE, Jang JY, Javed AA, Kazami Y, Kwon W, Lee M, Liu R, Motoi F, Perri G, Saiura A, Salvia R, Sasanuma H, Takeda Y, Wolfgang C, Zelga P, del Castillo CF, Marchegiani G, Besselink MG. Outcomes after distal pancreatectomy with or without splenectomy for intraductal papillary mucinous neoplasm: international multicentre cohort study. Br J Surg 2024; 111:znad424. [PMID: 38195084 PMCID: PMC10776207 DOI: 10.1093/bjs/znad424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/18/2023] [Accepted: 12/05/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND International guidelines on intraductal papillary mucinous neoplasm (IPMN) recommend a formal oncological resection including splenectomy when distal pancreatectomy is indicated. This study aimed to compare oncological and surgical outcomes after distal pancreatectomy with or without splenectomy in patients with presumed IPMN. METHODS An international, retrospective cohort study was undertaken in 14 high-volume centres from 7 countries including consecutive patients after distal pancreatectomy for IPMN (2005-2019). Patients were divided into spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS). The primary outcome was lymph node metastasis (LNM). Secondary outcomes were overall survival, duration of operation, blood loss, and secondary splenectomy. RESULTS Overall, 700 patients were included after distal pancreatectomy for IPMN; 123 underwent SPDP (17.6%) and 577 DPS (82.4%). The rate of malignancy was 29.6% (137 patients) and the overall rate of LNM 6.7% (47 patients). Patients with preoperative suspicion of malignancy had a LNM rate of 17.2% (23 of 134) versus 4.3% (23 of 539) among patients without suspected malignancy (P < 0.001). Overall, SPDP was associated with a shorter operating time (median 180 versus 226 min; P = 0.001), less blood loss (100 versus 336 ml; P = 0.001), and shorter hospital stay (5 versus 8 days; P < 0.001). No significant difference in overall survival was observed between SPDP and DPS for IPMN after correction for prognostic factors (HR 0.50, 95% c.i. 0.22 to 1.18; P = 0.504). CONCLUSION This international cohort study found LNM in 6.7% of patients undergoing distal pancreatectomy for IPMN. In patients without preoperative suspicion of malignancy, SPDP seemed oncologically safe and was associated with improved short-term outcomes compared with DPS.
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Affiliation(s)
- Myrte Gorris
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Eduard A van Bodegraven
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Mohammad Abu Hilal
- Department of Hepatopancreatobiliary Surgery, University Hospital Southampton, Southampton, UK
- Department of Surgery, Foundation Poliambulanza, Brescia, Italy
| | - Louisa Bolm
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Marco del Chiaro
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Joseph Habib
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ammar A Javed
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yusuke Kazami
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Mirang Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, First Medical Centre of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Fuyuhiko Motoi
- Department of Surgery I, Yamagata University, Yamagata, Japan
| | - Giampaolo Perri
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Akio Saiura
- Department of Hepatobiliary–Pancreatic Surgery, Juntendo University School of Medicine, Hongo, Tokyo, Japan
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Hideki Sasanuma
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yoshinori Takeda
- Department of Hepatobiliary–Pancreatic Surgery, Juntendo University School of Medicine, Hongo, Tokyo, Japan
| | | | - Piotr Zelga
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Amsterdam, the Netherlands
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Kato H, Asano Y, Ito M, Arakawa S, Horiguchi A. Recent trends in organ-preserving pancreatectomy: Its problems and clinical advantages compared with other standard pancreatectomies. Ann Gastroenterol Surg 2024; 8:8-20. [PMID: 38250689 PMCID: PMC10797825 DOI: 10.1002/ags3.12746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/06/2023] [Accepted: 09/24/2023] [Indexed: 01/23/2024] Open
Abstract
In this review article, we focus on recent papers on organ-preserving pancreatectomy procedures published since 2010. When comparing central pancreatectomy (CP) and distal pancreatectomy (DP), most studies have concluded that the CP group exhibited significantly lower incidence of new-onset diabetes or diabetes exacerbation than the DP group postoperatively. However, because of increased incidence of morbidities such as pancreatic fistula, the surgeon faces a considerable trade-off between increased short-term morbidity and long-term preservation of endocrine function. When the outcomes of two types of spleen-preserving DP (Kimura and Warshaw procedures) are compared, most studies mentioned the low incidence of postoperative gastric varices and splenic infarction with the Kimura procedure. Although there are several reports regarding the effect of spleen preservation on prevention of postoperative infections, no report on the contribution of spleen preservation to the prevention of overwhelming post-splenectomy infection is seen. The advantages of duodenum-preserving pancreatic head resection (DPPHR) concerning endocrine and exocrine functions continue to be subjects of discussion, mainly due to the limited number of institutions that have adopted this approach; however, DPPHR should be presented as an option for patients due to its low incidence of postoperative cholangitis. Organ-preserving pancreatectomy requires meticulous surgical techniques, and postoperative complications may increase with this surgery compared with standard pancreatectomy, which may be influenced by the surgeon's skill and the surgical facility where the procedure is performed. Nonetheless, this technique has significant long-term advantages in terms of endocrine and exocrine functions and its wider adoption in the future is expected.
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Affiliation(s)
- Hiroyuki Kato
- Department of Gastroenterological SurgeryFujita Health University School of Medicine, Bantane HospitalNagoyaJapan
| | - Yukio Asano
- Department of Gastroenterological SurgeryFujita Health University School of Medicine, Bantane HospitalNagoyaJapan
| | - Masahiro Ito
- Department of Gastroenterological SurgeryFujita Health University School of Medicine, Bantane HospitalNagoyaJapan
| | - Satoshi Arakawa
- Department of Gastroenterological SurgeryFujita Health University School of Medicine, Bantane HospitalNagoyaJapan
| | - Akihiko Horiguchi
- Department of Gastroenterological SurgeryFujita Health University School of Medicine, Bantane HospitalNagoyaJapan
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Wysocki M, Borys M, Gałązka K, Stranek M, Budzyński A. Splenectomy and tumor size are risk factors for serious perioperative morbidity of laparoscopic distal pancreatectomies. POLISH JOURNAL OF SURGERY 2023; 96:6-12. [PMID: 38348977 DOI: 10.5604/01.3001.0053.9292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
<b><br>Introduction:</b> The determinants influencing the risk for complications of laparoscopic distal pancreatectomies (LDP) are not yet fully defined, thus we aimed to determine risk factors for serious perioperative morbidity after LDP with spleen preservation, LDP and radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas (RAMPS).</br> <b><br>Material and methods:</b> Retrospective cohort study of consecutive patients that underwent LDP between January 2019 and December 2022. The study group included cases of serious perioperative morbidity (III-V grades in Clavien-Dindo classification) during a 30-day period after operation. The control group consisted of patients without serious perioperative morbidity. As many as 142 patients were included in the study.</br> <b><br>Results:</b> Serious perioperative morbidity was found in 33 (23.24%) operated patients, while mortality in 3 cases (2.11%). Serious perioperative morbidity after LDP with spleen preservation was found in 9/68 (13.2%) patients (27.3% of the perioperative morbidity group). Thirteen out of 51 patients, i.e. 25.5%, after LDP with splenectomy were included in the perioperative morbidity group (39.4%). Serious perioperative morbidity after RAMPS was found in 11/23 (47.8%) patients (33.3% of the perioperative morbidity group). In multivariate logistic regression, the need for splenectomy during pancreatectomy (OR 3.66, 95%CI 1.20-11.18) and tumor above 28 millimeters in size (OR 3.01, 95%CI 1.19-9.59) were independent risk factors for serious perioperative morbidity.</br> <b><br>Conclusions:</b> The need for splenectomy during laparoscopic distal pancreatectomy and tumor size above 28 millimeters were independent risk factors for serious perioperative morbidity after laparoscopic distal pancreatectomies.</br>.
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Affiliation(s)
- Michal Wysocki
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital, Cracow, Poland
| | - Maciej Borys
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital, Cracow, Poland
| | - Krystyna Gałązka
- Department of Pathomorphology, Jagiellonian University Medical College, Cracow, Poland
| | - Maciej Stranek
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital, Cracow, Poland
| | - Andrzej Budzyński
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital, Cracow, Poland
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Short-term Outcomes After Spleen-preserving Minimally Invasive Distal Pancreatectomy With or Without Preservation of Splenic Vessels: A Pan-European Retrospective Study in High-volume Centers. Ann Surg 2023; 277:e119-e125. [PMID: 34091515 DOI: 10.1097/sla.0000000000004963] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare short-term clinical outcomes after Kimura and Warshaw MIDP. BACKGROUND Spleen preservation during distal pancreatectomy can be achieved by either preservation (Kimura) or resection (Warshaw) of the splenic vessels. Multicenter studies reporting outcomes of Kimura and Warshaw spleen-preserving MIDP are scarce. METHODS Multicenter retrospective study including consecutive MIDP procedures intended to be spleen-preserving from 29 high-volume centers (≥15 distal pancreatectomies annually) in 8 European countries. Primary outcomes were secondary splenectomy for ischemia and major (Clavien-Dindo grade ≥III) complications. Sensitivity analysis assessed the impact of excluding ("rescue") Warshaw procedures which were performed in centers that typically (>75%) performed Kimura MIDP. RESULTS Overall, 1095 patients after MIDP were included with successful splenic preservation in 878 patients (80%), including 634 Kimura and 244 Warshaw procedures. Rates of clinically relevant splenic ischemia (0.6% vs 1.6%, P = 0.127) and major complications (11.5% vs 14.4%, P = 0.308) did not differ significantly between Kimura and Warshaw MIDP, respectively. Mortality rates were higher after Warshaw MIDP (0.0% vs 1.2%, P = 0.023), and decreased in the sensitivity analysis (0.0% vs 0.6%, P = 0.052). Kimura MIDP was associated with longer operative time (202 vs 184 minutes, P = 0.033) and less blood loss (100 vs 150 mL, P < 0.001) as compared to Warshaw MIDP. Unplanned splenectomy was associated with a higher conversion rate (20.7% vs 5.0%, P < 0.001). CONCLUSIONS Kimura and Warshaw spleen-preserving MIDP provide equivalent short-term outcomes with low rates of secondary splenectomy and postoperative morbidity. Further analyses of long-term outcomes are needed.
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Song KB, Hong S, Kim HJ, Park Y, Kwon J, Lee W, Jun E, Lee JH, Hwang DW, Kim SC. Predictive Factors Associated with Complications after Laparoscopic Distal Pancreatectomy. J Clin Med 2020; 9:jcm9092766. [PMID: 32858997 PMCID: PMC7563868 DOI: 10.3390/jcm9092766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 02/08/2023] Open
Abstract
Although laparoscopic distal pancreatectomy (LDP) has become more popular, the postoperative complication rate remains high. We sought to identify the risk factors for post-LDP complications. We examined 1227 patients who underwent LDP between March 2005 and December 2015 at a single large-volume center. We used logistic regression for the analysis. The overall (13.2%) and major (3.3%) complication rates were determined. Postoperative pancreatic fistula was the most frequent complication, and 58 patients (4.7%) had clinically significant (grade B) pancreatic fistulas. No 90-day mortality was recorded. Long operative time (≥200 min), large estimated blood loss (≥320 mL), LDP performed by an inexperienced surgeon (<50 cases), and concomitant splenectomy were identified as risk factors for overall complications using a logistic regression model. For major complications, male sex (p = 0.020), long operative time (p = 0.005), and LDP performed by an inexperienced surgeon (p = 0.026) were significant predictive factors. Using logistic regression analysis, surgery-related factors, including long operative time and LDP performed by an inexperienced surgeon, were correlated with overall and major complications of LDP. As LDP is a technically challenging procedure, surgery-related variables emerged as the main risk factors for postoperative complications. Appropriate patient selection and sufficient surgeon experience may be essential to reduce the complications of LDP.
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Affiliation(s)
- Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (K.B.S.); (S.H.); (Y.P.); (J.K.); (W.L.); (E.J.); (J.H.L.); (D.W.H.)
| | - Sarang Hong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (K.B.S.); (S.H.); (Y.P.); (J.K.); (W.L.); (E.J.); (J.H.L.); (D.W.H.)
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea;
| | - Yejong Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (K.B.S.); (S.H.); (Y.P.); (J.K.); (W.L.); (E.J.); (J.H.L.); (D.W.H.)
| | - Jaewoo Kwon
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (K.B.S.); (S.H.); (Y.P.); (J.K.); (W.L.); (E.J.); (J.H.L.); (D.W.H.)
| | - Woohyung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (K.B.S.); (S.H.); (Y.P.); (J.K.); (W.L.); (E.J.); (J.H.L.); (D.W.H.)
| | - Eunsung Jun
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (K.B.S.); (S.H.); (Y.P.); (J.K.); (W.L.); (E.J.); (J.H.L.); (D.W.H.)
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (K.B.S.); (S.H.); (Y.P.); (J.K.); (W.L.); (E.J.); (J.H.L.); (D.W.H.)
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (K.B.S.); (S.H.); (Y.P.); (J.K.); (W.L.); (E.J.); (J.H.L.); (D.W.H.)
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (K.B.S.); (S.H.); (Y.P.); (J.K.); (W.L.); (E.J.); (J.H.L.); (D.W.H.)
- Correspondence: ; Tel.: +82-2-3010-3936; Fax: +82-2-3010-6701
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Mazzola M, Crippa J, Bertoglio CL, Andreani S, Morini L, Sfondrini S, Ferrari G. Postoperative risk of pancreatic fistula after distal pancreatectomy with or without spleen preservation. TUMORI JOURNAL 2020; 107:160-165. [PMID: 32635820 DOI: 10.1177/0300891620936744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Outcomes after distal pancreatectomy with or without splenectomy are controversial. The present study aims to investigate differences in short-term and long-term outcomes between spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS). METHODS In this retrospective review of consecutive patients undergoing distal pancreatectomy with or without splenectomy from January 2011 until December 2017 for benign disease, the primary endpoint was to compare postoperative pancreatic fistula (POPF). The secondary endpoint was to compare duration of surgery, intraoperative blood loss, postoperative complications, length of hospital stay, and long-term outcomes. RESULTS Patients undergoing SPDP had a lower rate of POPF (13.6% vs 46.1%; p = 0.02). Patients undergoing SPDP (n = 22) were discharged earlier than patients undergoing DPS (n = 26) (8 [4-29] vs 12 [6.48] days; p = 0.003). No differences in other intraoperative and postoperative outcomes were found between groups. CONCLUSION Patients undergoing SPDP developed fewer POPF and were discharged earlier compared to patients undergoing DPS.
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Affiliation(s)
- Michele Mazzola
- Division of Oncologic and Minimally-invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Jacopo Crippa
- Division of Oncologic and Minimally-invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Camillo L Bertoglio
- Division of Oncologic and Minimally-invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Sara Andreani
- Division of Oncologic and Minimally-invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenzo Morini
- Division of Oncologic and Minimally-invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano Sfondrini
- Division of Oncologic and Minimally-invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Ferrari
- Division of Oncologic and Minimally-invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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9
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Yang SJ, Hwang HK, Kang CM, Lee WJ. Revisiting the potential advantage of robotic surgical system in spleen-preserving distal pancreatectomy over conventional laparoscopic approach. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:188. [PMID: 32309335 PMCID: PMC7154491 DOI: 10.21037/atm.2020.01.80] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background This study aimed to compare success rate of spleen preservation between robotic and laparoscopic distal pancreatectomy (DP). Methods Between November 2007 and March 2018, forty-one patients underwent the conventional laparoscopic DP (Lap group) and the other 37 patients underwent robotic DP (Robot group). The perioperative clinicopathologic variables were compared. Results The robotic procedure was chosen by younger patients compared to conventional laparoscopic surgery (42.9±14.0 vs. 51.3±14.6 years, P=0.016). The mean operation time was longer (313 vs. 246 min, P=0.000), but the mean tumor size was smaller in Robot group (2.7±1.2 vs. 4.2±3.3 cm, P=0.018). The overall spleen-preserving rate was higher in the Robot group (91.9% vs. 68.3%, P=0.012). However, with accumulating laparoscopic experiences (after 16th case), the statistical differences in spleen preservation rate between the Robot and Lap groups had diminished (P=0.428). Conclusions The present results suggest a robot can be helpful to save the spleen during DP for benign and borderline malignancy. However, a surgeon highly experienced in the laparoscopic approach can also produce a high success rate of spleen preservation, similar to that shown with the robotic approach.
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Affiliation(s)
- Seok Jeong Yang
- Department of Surgery, Yonsei University College of Medicine, Yongin Severance Hospital, Gyeonggi, Korea
| | - Ho Kyoung Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Yonsei Cancer Center, Severance Hospital, Seoul, Korea.,Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Chang Moo Kang
- Division of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Yonsei Cancer Center, Severance Hospital, Seoul, Korea.,Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Woo Jung Lee
- Department of Surgery, Yonsei University College of Medicine, Yongin Severance Hospital, Gyeonggi, Korea
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10
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Collard M, Marchese T, Guedj N, Cauchy F, Chassaing C, Ronot M, Dokmak S, Soubrane O, Sauvanet A. Is Routine Splenectomy Justified for All Left-Sided Pancreatic Cancers? Histological Reappraisal of Splenic Hilar Lymphadenectomy. Ann Surg Oncol 2019; 26:1071-1078. [PMID: 30607766 DOI: 10.1245/s10434-018-07123-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although splenectomy is recommended during resection for left-sided resectable pancreatic ductal adenocarcinoma (PDAC) to perform lymphadenectomy of station 10 (splenic hilum), no level I evidence justifies this procedure. This study aims to evaluate the rate of lymph node (LN) and contiguous involvement of the splenic hilum in resectable distal PDAC. METHODS We retrospectively reviewed all patients who underwent splenopancreatectomy for PDAC in the past 10 years. Station 10 LN were routinely isolated, and all corresponding microscopic slides were reinterpreted by a pathologist. The computed tomography (CT) results of patients with tumoral involvement of the spleen or splenic hilum by contiguity (TISOSH) and ≤ 10 mm between the tumor and spleen on pathology were blindly reviewed by two radiologists to evaluate CT for diagnosis of TISOSH. RESULTS We included 110 consecutive patients, including 104 with analyzable station 10 LN. The tumor was N+ in 58 (53%) patients. The median number of LN identified at station 10 was 2.0 ± 3.0. No station 10 LNs were detected in 42 (40%) patients. No patients had tumor-positive LN at station 10. TISOSH was found in nine (8%) patients, and was significantly associated with tail location (p = 0.001), tumor size (p = 0.005), and multivisceral involvement (p = 0.015). For diagnosis of TISOSH, the sensitivity and specificity of CT were respectively 89% and 95% for radiologist 1 and 89% and 100% for radiologist 2. CONCLUSIONS Splenic preservation during resection of distal PDAC may be an option in selected patients with body tumors and no suspected splenic or splenic hilum involvement on preoperative CT.
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Affiliation(s)
- Maxime Collard
- Department of Hepato-Pancreatico-Biliary Surgery, Pôle des maladies de l'Appareil Digestif, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France
| | - Tiziana Marchese
- Department of Hepato-Pancreatico-Biliary Surgery, Pôle des maladies de l'Appareil Digestif, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France
| | - Nathalie Guedj
- Departments of Pathology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France.,Université Paris Diderot, Paris, France
| | - François Cauchy
- Department of Hepato-Pancreatico-Biliary Surgery, Pôle des maladies de l'Appareil Digestif, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France
| | - Caroline Chassaing
- Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France
| | - Maxime Ronot
- Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France.,Université Paris Diderot, Paris, France
| | - Safi Dokmak
- Department of Hepato-Pancreatico-Biliary Surgery, Pôle des maladies de l'Appareil Digestif, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France
| | - Olivier Soubrane
- Department of Hepato-Pancreatico-Biliary Surgery, Pôle des maladies de l'Appareil Digestif, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France.,Université Paris Diderot, Paris, France
| | - Alain Sauvanet
- Department of Hepato-Pancreatico-Biliary Surgery, Pôle des maladies de l'Appareil Digestif, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France. .,Université Paris Diderot, Paris, France.
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11
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Milito P, Aiolfi A, Asti E, Rausa E, Bonitta G, Bonavina L. Impact of Spleen Preserving Laparoscopic Distal Pancreatectomy on Postoperative Infectious Complications: Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2018; 29:167-177. [PMID: 30592691 DOI: 10.1089/lap.2018.0738] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Laparoscopic distal pancreatectomy with splenectomy is the standard procedure for body and tail pancreatic tumors. Technical difficulties arising from the strict anatomical relationship between pancreas and splenic vessels generally impose a concomitant splenectomy. Previous retrospective studies have shown a reduced risk of postoperative complications and infections in spleen preserved patients, but this is still a debated issue. Aim of this systematic review and meta-analysis was to provide a more robust evidence on the effect of spleen preserving laparoscopic distal pancreatectomy. METHODS PubMed, MEDLINE, Embase, and Cochrane databases were consulted. Pooled effect measures were calculated using an inverse-variance weighted or Mantel-Haenszel in random effects meta-analysis. Heterogeneity was evaluated using I2-index and Cochran Q-test. RESULTS Ten observational studies were eligible, and 632 patients were included in the quantitative analysis. Overall, 296 (46.8%) patients underwent laparoscopic distal pancreatectomy with splenectomy (Group S), and 336 (53.2%) patients underwent spleen-preserving laparoscopic distal pancreatectomy (Group SP). In-hospital mortality was 0%. In the group S, the estimated pooled odds ratio of postoperative surgical site infection (SSI) and overall complications was 1.51 (95% confidence interval [CI]: 1.01-2.28; P = .048) and 2.30 (95% CI: 1.11-4.76; P = .024). The estimated pooled odds ratio of pancreatic fistula, postoperative bleeding, and reoperation was 1.64 (P = .094), 1.01 (P = .987), and 1.24 (P = .776), respectively. CONCLUSIONS Spleen-preserving laparoscopic distal pancreatectomy may reduce postoperative SSI and overall complications. These results should be interpreted with caution but seem meaningful to establish a better evidence-based treatment for distal pancreatic tumors. Further studies are warranted to analyze the role of spleen preserving laparoscopic distal pancreatectomy on long-term outcomes.
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Affiliation(s)
- Pamela Milito
- Division of General Surgery IRCCS Policlinico San Donato, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Alberto Aiolfi
- Division of General Surgery IRCCS Policlinico San Donato, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Emanuele Asti
- Division of General Surgery IRCCS Policlinico San Donato, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Emanuele Rausa
- Division of General Surgery IRCCS Policlinico San Donato, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Gianluca Bonitta
- Division of General Surgery IRCCS Policlinico San Donato, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Luigi Bonavina
- Division of General Surgery IRCCS Policlinico San Donato, Department of Biomedical Science for Health, University of Milan, Milan, Italy
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12
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The treatment indication and optimal management of fluid collection after laparoscopic distal pancreatectomy. Surg Endosc 2018; 33:3314-3324. [PMID: 30535935 DOI: 10.1007/s00464-018-06621-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recently, laparoscopic distal pancreatectomy (LDP) has become the standard procedure for resection of left-sided pancreatic tumors. Fluid collection (FC) at the resection margin of the pancreatic stump after LDP is a frequent radiological finding. However, there have been few treatment guidelines and the optimal management for this clinical finding is unclear. The aim of present study is to define the incidence of FC and suggest the optimal management for FC after LDP. METHODS A total of 1227 patients who underwent LDP between March 2005 and December 2015 were collected. FC was considered present when the longest diameter of the lesion on CT scan was > 3 cm. RESULTS A follow-up with at least two CT image was available for 1102 patients. Of these, 689 (62.5%) patients showed initial fluid collection (IFC) at the pancreas resection site in immediate postoperative CT. IFC (+) group had higher proportion of men, BMI, and higher rate of concomitant splenectomy than IFC (-) group. Among patients with FC after LDP, the treatment group had more frequent leukocytosis and accompanying symptoms than the observation group. Seventy-seven patients underwent therapeutic interventions for FC after LDP. Among them, 55 (71.4%) patients underwent endoscopic ultrasonography-guided gastrocystostomy (EUS-GC). EUS-GC group had a higher success rate (85.6 vs. 63.6%, p < 0.033) and shorter hospital stay after the intervention (5.2 vs. 13.3 days, p < 0.001) than those who underwent other procedures. CONCLUSIONS High BMI, male, and concomitant splenectomy contribute to the occurrence of FC after LDP. In most cases, FC after LDP resolved spontaneously over time with observation. The patients with symptomatic FC ultimately required treatment. EUS-GC is the optimal intervention therapy for FC after LDP.
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13
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Pendola F, Gadde R, Ripat C, Sharma R, Picado O, Lobo L, Sleeman D, Livingstone AS, Merchant N, Yakoub D. Distal pancreatectomy for benign and low grade malignant tumors: Short-term postoperative outcomes of spleen preservation-A systematic review and update meta-analysis. J Surg Oncol 2017; 115:137-143. [PMID: 28133818 DOI: 10.1002/jso.24507] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 10/21/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND The value of spleen preservation with distal pancreatectomy (DP) for benign and low grade malignant tumors remains unclear. The aim of this study was to evaluate the short-term postoperative clinical outcomes in patients undergoing DP with splenectomy (DPS) or spleen preservation (SPDP). METHODS Online database search was performed (2000 to present); key bibliographies were reviewed. Studies comparing patients undergoing DP with either DPS or SPDP, and assessing postoperative complications were included. RESULTS Meta-analysis of included data showed SPDP patients had significantly less operative blood loss, shorter duration of hospitalization, lower incidence of fluid collection and abscess, lower incidence of postoperative splenic and portal vein thrombosis, and lower incidence of new onset postoperative diabetes. For the whole group, there was no difference in incidence of postoperative pancreatic fistula (POPF) (RR = 0.95; 95%CI 0.65-1.40, P = 0.80), however, subgroup analysis of studies using ISGPF criteria showed that DPS patients had increased rates of Grade B/C POPF (RR = 1.35; 95%CI 1.08-1.70, P = 0.01). CONCLUSIONS SPDP for benign and low grade malignant tumors is associated with shorter hospital stay and decreased morbidity compared to DPS. J. Surg. Oncol. 2017;115:137-143. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Fiorella Pendola
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, Florida
| | - Rahul Gadde
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Caroline Ripat
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Rishika Sharma
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Omar Picado
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Laila Lobo
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Danny Sleeman
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Alan S Livingstone
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, Florida
| | - Nipun Merchant
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, Florida
| | - Danny Yakoub
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, Florida
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14
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Yamada M, Sugiura T, Okamura Y, Ito T, Yamamoto Y, Ashida R, Uesaka K. Middle segment-preserving pancreatectomy for metachronous intraductal papillary mucinous neoplasm after pancreatoduodenectomy: a case report. Surg Case Rep 2017; 3:28. [PMID: 28197897 PMCID: PMC5309193 DOI: 10.1186/s40792-017-0306-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/10/2017] [Indexed: 11/22/2022] Open
Abstract
Total pancreatectomy has occasionally been performed to treat patients with multiple lesions (such as intraductal papillary mucinous neoplasm (IPMN)) or patients who have undergone repeated pancreatic resection. However, deficiencies of the exocrine and endocrine functions worsen patients’ quality of life. Recently, there have been several case reports citing middle segment-preserving pancreatectomy (MSPP) as a safe procedure and beneficial with respect to preservation of the exocrine and endocrine functions. We herein report the case of a patient who underwent MSPP for repeat pancreatectomy for IPMN and in whom a favorable outcome was achieved. The patient, a 70-year-old man, was diagnosed with branch duct-type IPMN (BD-IPMN) with worrisome features in the pancreatic head and a single cyst in the pancreatic tail, during a preoperative examination of early gastric cancer. Pancreatoduodenectomy was performed for BD-IPMN in the pancreatic head and gastric cancer. A histopathological examination showed an intraductal papillary mucinous adenoma (IPMA) with mild-moderate atypia. During the follow-up, the size of the cystic lesion in the pancreatic tail and the diameter of the main pancreatic duct were gradually increasing. Therefore, at 2 years and 6 months after surgery, distal pancreatectomy with preservation of the spleen (namely MSPP) was performed. The pancreatic resection margin was histologically negative. The length and volume of the remnant pancreas were approximately 6 cm and 10 ml, respectively. A histopathological examination showed an IPMA. The patient had no diarrhea or weight loss without digestive enzymes and maintained favorable glucose tolerance without oral hypoglycemic agents or insulin. He has showed no evidence of new lesions in the remnant pancreas at 3 years of follow-up after the last surgery.
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Affiliation(s)
- Mihoko Yamada
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Shizuoka, Japan
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Shizuoka, Japan.
| | - Yukiyasu Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Shizuoka, Japan
| | - Takaaki Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Shizuoka, Japan
| | - Yusuke Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Shizuoka, Japan
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Shizuoka, Japan
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15
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Dai MH, Shi N, Xing C, Liao Q, Zhang TP, Chen G, Wu WM, Guo JC, Liu ZW, Zhao YP. Splenic preservation in laparoscopic distal pancreatectomy. Br J Surg 2016; 104:452-462. [PMID: 28004852 DOI: 10.1002/bjs.10434] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/10/2016] [Accepted: 10/26/2016] [Indexed: 12/19/2022]
Abstract
Abstract
Background
Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is designed principally for the removal of benign and low-grade malignant lesions in the left pancreas. The aims of this study were to compare LSPDP with laparoscopic distal pancreatectomy with splenectomy (LDPS), compare two splenic preservation techniques (splenic vessel preservation and Warshaw technique) and investigate factors that influence splenic preservation.
Methods
Information from patients who underwent laparoscopic distal pancreatectomy between December 2004 and January 2016 at a single institution was reviewed. Data were extracted from a prospectively developed database. Intention-to-treat and propensity score matching analyses were employed. Univariable and multivariable analyses were used to investigate factors affecting splenic preservation.
Results
There were 206 patients in total (126 planned LSPDP and 80 planned LDPS procedures), of whom 108 underwent LSPDP and 98 LDPS. In intention-to-treat analysis, the duration of surgery was significantly shorter in the LSPDP group than in the LDPS group (mean 191·0 versus 220·5 min respectively; P < 0·001). Tumour size was an independent risk factor for splenic vessel resection in planned splenic vessel preservation operations, and a cut-off value of 3 cm provided optimal diagnostic accuracy. After a median follow-up of 35·9 months, there were no clinically significant splenic infarctions and no patient developed gastrointestinal bleeding after LSPDP.
Conclusion
Planned LSPDP had a high splenic preservation rate and was associated with significantly shorter operating time than LDPS. Splenic vessel preservation could be predicted using a tumour cut-off size of 3 cm.
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Affiliation(s)
- M-H Dai
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - N Shi
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - C Xing
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Q Liao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - T-P Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - G Chen
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - W-M Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - J-C Guo
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Z-W Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Y-P Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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16
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Shi N, Liu SL, Li YT, You L, Dai MH, Zhao YP. Splenic Preservation Versus Splenectomy During Distal Pancreatectomy: A Systematic Review and Meta-analysis. Ann Surg Oncol 2016; 23:365-74. [PMID: 26493758 DOI: 10.1245/s10434-015-4870-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Studies have been published comparing spleen-preserving distal pancreatectomy (SPDP) with distal pancreatectomy with splenectomy (DPS), but the results remain inconsistent. The aim of this study was to compare SPDP with DPS by conducting a systematic review and meta-analysis. METHODS Literature searches of the Medline/PubMed, Embase, and Cochrane Library databases were performed to identify relevant studies published before April 30,2015. Perioperative outcomes of SPDP and DPS were evaluated. The meta-analysis was performed in random- or fixed-effects models, as appropriate. A subanalysis was conducted to compare the two techniques of splenic preservation: splenic vessel preservation (SVP) and Warshaw technique (WT). RESULTS Eighteen studies and 1156 patients were included in the comparison between SPDP and DPS. A total of 502 of these patients underwent SPDP and 654 underwent DPS. Meta-analysis showed the SPDP group had significantly fewer infectious complications (odds ratio [OR] 0.57, P = 0.006), less operative blood loss (P<0.0001), lower overall morbidity rate (OR 0.66, P = 0.002), and lower clinical pancreatic fistula rate (OR 0.42, P = 0.002) than the DPS group. Subanalysis indicated the SVP group had significantly lower rate of spleen infarction (OR 0.12, P<0.00001) and fewer secondary splenectomies (OR 0.13, P = 0.008) than the WT group. CONCLUSIONS SPDP was a safe procedure associated with better short-term outcomes than DPS. SVP could provide more sufficient blood perfusion for the conserved spleen than WT. However, the evidence is limited, and more randomized controlled trials are warranted.
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17
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Affiliation(s)
- A N Smolyar
- Department of acute liver and pancreatic surgical diseases, Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
| | - K T Agakhanova
- Department of acute liver and pancreatic surgical diseases, Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
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18
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Kwon W, Jang JY, Kim JH, Chang YR, Jung W, Kang MJ, Kim SW. An Analysis of Complications, Quality of Life, and Nutritional Index After Laparoscopic Distal Pancreatectomy with Regard to Spleen Preservation. J Laparoendosc Adv Surg Tech A 2016; 26:335-42. [DOI: 10.1089/lap.2015.0171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ye Rim Chang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Woohyun Jung
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Mee Joo Kang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sun-Whe Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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19
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Lin SR, Xiao WD. Current research status of organ preserving pancreatectomy. Shijie Huaren Xiaohua Zazhi 2015; 23:5318-5324. [DOI: 10.11569/wcjd.v23.i33.5318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Classic pancreatectomy procedures usually require resection of the pancreas and surrounding organs, having disadvantages of major trauma, long hospital stay and high morbidity. In order to preserve organ function as much as possible, many types of organ preserving pancreatectomy have been widely used in the treatment of benign pancreatic tumors and low-grade malignant lesions, including tumor enucleation, pylorus preserving pancreaticoduodenectomy, duodenum-preserving pancreatic head resection, middle segmental pancreatectomy, and spleen-preserving distal pancreatectomy. With the development of minimally invasive techniques in recent years, laparoscopic and robotic techniques have been also safely applied in organ preserving pancreatectomy. This article will review the current research status of organ preserving pancreatectomy.
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20
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Panda N, Bansal NK, Narsimhan M, Ardhanari R, Bronson JRB. Spleen-Preserving Versus Spleen-Sacrificing Distal Pancreatectomy in Laparoscopy and Open Method-Perioperative Outcome Analysis-14 Years Experience. Indian J Surg 2015; 78:90-5. [PMID: 27303115 DOI: 10.1007/s12262-015-1324-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/18/2015] [Indexed: 01/27/2023] Open
Abstract
We analyzed perioperative outcome of distal pancreatectomies with or without splenic preservation both in laparoscopic and open method to determine best approach. Retrospective data was collected from 1999 to 2013. We divided all distal pancreatectomies into four groups. Group 1-laparoscopic spleen-preserving distal pancreatectomy (LSPDP). Group 2-laparoscopic splenectomy + distal pancreatectomy (LSDP). Group 3-open spleen-preserving distal pancreatectomy. Group 4-open splenectomy + distal pancreatectomy. We recorded demographic data, intra and post operative complications, operative time, estimated blood loss, length of stay, pancreatic leak rate, and final pathology result. A total of 38 distal pancreatectomies were included. In group 1, patients were significantly younger (mean 29 vs 47 to 50 in other groups, p = 0.014). Tumor size (average 2.5 vs 5 to 9.5 cm in other groups, p = 0.023) and operative time (average 98 min vs 125 to 141 in other groups, p = 0.004) and hospital stay (average 6 vs 8 to 19 days in other groups, p = 0.009) in LSPDP were all significantly less than other groups taken together. However, intra-operative blood loss was equivalent. We further analyzed that between LSPDP and LSDP, age and tumor size were significantly less in LSPDP. Further we analyzed between spleen-preserving (groups 1 + 3) vs spleen-sacrificing (groups 2 + 4) distal pancreatectomies and between overall laparoscopic (groups 1 + 2) vs open (groups 3 + 4). Laparoscopic spleen-preserving distal pancreatectomy has all the advantages of minimal access surgery especially in small lesions and low-grade malignancy.
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Affiliation(s)
- Nilanjan Panda
- Department of Surgical Gastroenterology, Meenakshi Mission Hospital and Research Center, Madurai, India ; R G Kar Medical College, P 318 b, CIT Road, Scheme 6M, Kankurgachi, Kolkata, 700054 West Bengal India
| | - Nitin Kumar Bansal
- Department of Surgical Gastroenterology, Meenakshi Mission Hospital and Research Center, Madurai, India
| | - Mohan Narsimhan
- Department of Surgical Gastroenterology, Meenakshi Mission Hospital and Research Center, Madurai, India
| | - Ramesh Ardhanari
- Department of Surgical Gastroenterology, Meenakshi Mission Hospital and Research Center, Madurai, India
| | - Joseph Raja B Bronson
- Department of Surgical Gastroenterology, Meenakshi Mission Hospital and Research Center, Madurai, India
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