Top

Surgical Endoscopy

Published in:

01-07-2021 | Pancreatectomy

Comparison of clinical outcomes and quality of life between laparoscopic distal pancreatectomy with or without spleen preservation

Authors: Ren-Chao Zhang, Jun Ma, Yi-Ping Mou, Jia-Fei Yan, Yu-Cheng Zhou

Published in: Surgical Endoscopy | Issue 7/2021

Abstract

Background

The studies comparing laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and laparoscopic distal pancreatosplenectomy (LDPS) are limited. This study aimed to compare clinical outcomes and quality of life of patients undergoing LSPDP and LDPS.

Methods

Between March 2004 and December 2014, patients who underwent laparoscopic distal pancreatectomy were reviewed. Patients were divided into 2 groups as LSPDP and LDPS. Data considered for comparison analysis were patient demographics, intraoperative variables, morbidity, postoperative hospital stay, mortality, pathologic findings, and quality of life (SF-36 questionnaire).

Results

A total of 110 patients (50 LSPDP and 60 LDPS) were included in the final analysis. Baseline characteristics were similar in the 2 groups. The LSPDP group had a significantly shorter operative time(153.3 ± 46.2 vs. 179.9 ± 54.1 min, p = 0.015) than the LDPS group. Also in analysis of propensity-matched population(LSPDP:LDPS = 35:35, 1:1 matching), LSPDP group still had a significantly shorter operative time (159.3 ± 36.2 vs. 172.9 ± 44.1 min, p = 0.045) than the LDPS group.There were no significant differences with respect to estimated blood loss, first flatus time, diet start time, and postoperative hospital stay. Postoperative outcomes, including morbidity, pancreatic fistula rates, and mortality, were similar in the LSPDP and LDPS group. On the follow-up survey, the total quality of life score (635.8 ± 50.7 vs. 596.1 ± 92.1)was higher in the LSPDP group compared with the LDPS group. However, the differences were not statistically significant(p > 0.05). The score in vitality (82.5 ± 14.4 vs. 68.9 ± 11.4, p = 0.046) was significantly higher in LSPDP group and not statistically significant in other areas (p > 0.05).Similar results of quality of life assessment were found in analysis of propensity-matched population.

Conclusions

Compared to LDPS, LSPDP had shorter operating time and better quality of life with similar morbidity and recovery period.

Di Sabatino A, Carsetti R, Corazza GR (2011) Post-splenectomy and hyposplenic states. Lancet 378(9785):86–97CrossRef

Kristinsson SY, Gridley G, Hoover RN et al (2014) Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up. Haematologica 99(2):392–398CrossRef

Shi N, Liu S-L, Li Y-T et al (2016) Splenic preservation versus splenectomy during distal pancreatectomy: a systematic review and meta-analysis. Ann Surg Onco 23(2):365–374CrossRef

Kooby DA, Vollmer CM (2015) Laparoscopic versus open distal pancreatectomy: is a randomized trial necessary? J Hepatobiliary Pancreat Sci 22(10):737–739CrossRef

Mehrabi A, Hafezi M, Arvin J et al (2015) A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it's time to randomize. Surgery 157(1):45–55CrossRef

Nau P, Melvin WS, Narula VK et al (2009) Laparoscopic distal pancreatectomy with splenic conservation: an operation without increased morbidity. Gastroenterol Res Pract 2009:846340CrossRef

Zhao YP, Du X, Dai M-H et al (2012) Laparoscopic distal pancreatectomy with or without splenectomy: spleen-preservation does not increase morbidity. Hepatobiliary Pancreat Dis Int 11(5):536–541CrossRef

Choi SH, Mi AS, Hwang HK et al (2012) Is it worthwhile to preserve adult spleen in laparoscopic distal pancreatectomy? Perioperative and patient-reported outcome analysis. Surg Endosc 26(11):3149–3156CrossRef

Jiang C, Lv G-Y, Wang Y-C et al (2015) Comparison of Laparoscopic Distal Pancreatectomy with or without Splenic Preservation. Indian J Surg 77(Suppl 3):783–787CrossRef

10.

Panda N, Bansal NK, Narsimhan M et al (2016) Spleen-preserving versus spleen-sacrificing distal pancreatectomy in laparoscopy and open method-perioperative outcome analysis—14 years experience. Indian J Surg 78(2):90–95CrossRef

11.

Kwon W, Jang J-Y, Kim JH et al (2016) 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 26(5):335–342CrossRef

12.

Dai MH, Shi N, Xing C et al (2017) Splenic preservation in laparoscopic distal pancreatectomy. Br J Surg 104(4):452–462CrossRef

13.

Pais-Costa SR, Sousa GCC, Araujo SLM et al (2019) Laparoscopic distal pancreatectomy with or without spleen preservation:comparative analysis of short and long-term outcomeS. Arq Bras Cir Dig 32(3):e1461CrossRef

14.

Moekotte AL, Lof S, White SA et al (2020) Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensityscore-matched study. Surg Endosc 34(3):1301–1309CrossRef

15.

Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13CrossRef

16.

Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591CrossRef

17.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRef

18.

Hirono S, Tani M, Kawai M et al (2009) A central pancreatectomy for benign or low-grade malignant neoplasms. J Gastrointest Surg 13(9):1659–1665CrossRef

19.

Sullivan M, Karlsson J, Taft C (2002) SF-36 Hälsoenkät: Svensk Manual och Tolkningsguide, 2:a upplagan (Swedish Manual and Interpretation Guide, 2nd edition). Sahlgrenska University Hospital, Gothenburg

20.

Zhang RC, Yan JF, Xu XW et al (2013) Laparoscopic vs open distal pancreatectomy for solid pseudopapillary tumor of the pancreas. World J Gastroenterol 19(37):6272–6277CrossRef

21.

Yan JF, Xu XW, Jin WW et al (2014) Laparoscopic spleen-preserving distal pancreatectomy for pancreatic neoplasms: a retrospective study. World J Gastroenterol 20(38):13966–13972CrossRef

22.

Chen K, Pan Y, Mou YP et al (2019) Surgical outcomes of laparoscopic distal pancreatectomy in elderly and octogenarian patients: a single-center, comparative study. Surg Endosc 33(7):2142–2151CrossRef

23.

Kimura W, Inoue T, Futakawa N et al (1996) Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Surgery 120(5):885–890CrossRef

24.

Warshaw AL (1988) Conservation of the spleen with distal pancreatectomy. Arch Surg 123(5):550–553CrossRef

25.

Gagner M, Pomp A, Herrera MF (1996) Early experience with laparoscopic resections of islet cell tumors. Surgery 120(6):1051–1054CrossRef

26.

Nakata K, Shikata S, Ohtsuka T et al (2018) Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta-analysis. J Hepatobiliary Pancreat Sci 25(11):476–488CrossRef

27.

Adam JP, Jacquin A, Laurent C et al (2013) Laparoscopic spleen-preserving distal pancreatectomy: splenic vessel preservation compared with the Warshaw technique. JAMA Surg 148(3):246–252CrossRef

28.

Wang L, Wu D, Cheng YG et al (2019) Warshaw technique in laparoscopic spleen-preserving distal pancreatectomy: surgical strategy and late outcomes of splenic preservation. BioMed Res Int 2019:4074369PubMedPubMedCentral

Title: Comparison of clinical outcomes and quality of life between laparoscopic distal pancreatectomy with or without spleen preservation
Authors: Ren-Chao Zhang
Jun Ma
Yi-Ping Mou
Jia-Fei Yan
Yu-Cheng Zhou
Publication date: 01-07-2021
Publisher: Springer US
Keyword: Pancreatectomy
Published in: Surgical Endoscopy / Issue 7/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07783-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of clinical outcomes and quality of life between laparoscopic distal pancreatectomy with or without spleen preservation

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2021

An international survey on anastomotic stricture management after esophageal atresia repair: considerations and advisory statements

Endoscopic mucosal incision and muscle interruption (MIMI) for the treatment of Zenker’s diverticulum

Less is more in the difficult gallbladder: recent evolution of subtotal cholecystectomy in a single HPB unit

A validated score predicting common bile duct stone in patients hospitalized with acute calculus cholecystitis: a multi-center retrospective study

Safety and efficacy of magnetic sphincter augmentation dilation

The impact of intensive laparoscopic training course with structured assessment and immediate feedback on residents’ operative performance in animal lab