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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2016

01-02-2016 | Healthcare Policy and Outcomes

Splenic Preservation Versus Splenectomy During Distal Pancreatectomy: A Systematic Review and Meta-analysis

Authors: Ning Shi, MD, Shang-Long Liu, MD, Ya-Tong Li, MD, Lei You, PhD, Meng-Hua Dai, MD, Yu-Pei Zhao, MD

Published in: Annals of Surgical Oncology | Issue 2/2016

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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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Metadata
Title
Splenic Preservation Versus Splenectomy During Distal Pancreatectomy: A Systematic Review and Meta-analysis
Authors
Ning Shi, MD
Shang-Long Liu, MD
Ya-Tong Li, MD
Lei You, PhD
Meng-Hua Dai, MD
Yu-Pei Zhao, MD
Publication date
01-02-2016
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 2/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4870-z

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