Clinical comparison of laparoscopic distal pancreatectomy with or without Splenectomy: clinical outcomes and splenic function analysis

Xiaowu Xu, MD, Renchao Zhang, MD, Yiping Mou, MD, FACS, Weiwei Jin, MD, Jiafei Yan, MD, Miaozun Zhang, MD, Chaojie Huang, MD. Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University

Background:The studies on spleen-preserving laparoscopic distal pancreatectomy (SP-LDP) versus laparoscopic distal pancreatosplenectomy(LDPS) have not been as readily available. This study aimed to compare perioperative outcomes of patients undergoing SP-LDP and LDPS and to assess the function of spleen salvage.

Methods:A retrospective study was performed for patients who underwent SP-LDP or LDPS between 2004 and 2013. The patients’ demographic data, operative results, pathological reports, hospital courses, morbidity and mortality, and follow-up data (including splenic function) were compared between these two groups.

Results:114 cases were included in this study(SP-LDP= 34, LDPS=70).There were no significant differences in the operating time (173.3±46.4 vs 193.9±54.4min, P=0.635) and intraoperative blood loss (154.1±174.8vs 223.6±186.6ml, P=0.079) between these two groups. Mortality, morbidity (41.2% vs 38.6%,P=0.946), pancreatic fistula rates (≥grade B:11.8% vs 15.7%, P=0.958)were similar between the two groups. On postoperative days 14, LDPS group had more cases of PLT ≥ 300 * 10 ^ 9 / L than the SP – LDP group (46.7% vs 84.3%, P = 0.000). Four patients(11.8%)developed spleen focal infarction, 3 patients (8.8%) with splenic vein stenosis or occlusion. The other patients were with normal patency of the splenic vessels. The score in vitality of SF-36 was higher in the SP-LDP group(82.5±14.4 vs 68.9±11.4, P=0.046).

Conclusions:SP-LDP is a procedure as safe and feasible as LDPS and could preserve the splenic function.

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