Objective A distal pancreatectomy has routinely been used for removing benign/borderline malignant tumors of the body and tail of the pancreas; however, controversy exists whether or not the spleen should be saved. Therefore, we conducted this meta-analysis for comparing the clinical outcomes of patients who underwent distal pancreatectomy with or without splenectomy. Methods A literature research from the databases of Medline, Embase, and Cochrane library was performed to evaluate and compare the clinical outcomes between spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS). Pooled odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (95% CI) were calculated using fixed-effects or random-effects models. Results Eleven non-randomized controlled studies involving 897 patients were selected to satisfy the inclusion criteria; 355 patients underwent SPDP and 542 patients underwent DPS. Compared with DPS, SPDP required a shorter hospital stay (WMD = 1.16, 95% CI = ？2.00 to ？0.31, P = 0.007), and had a lower incidence of intra-abdominal abscesses (OR = 0.48, 95% CI = 0.27 to 0.83, P = 0.009). In addition, spleen infarctions occurred in SPDP, most of which involved use of the Warshaw method for preserving the spleen. There were no differences between the SPDP and DPS groups with respect to operative time, operative blood loss, requirement for blood transfusion, pancreatic fistulas, thromboses, post-operative bleeding, wound infections and re-operation rates. Conclusion SPDP should be performed due to the benefits of the immune system and quick post-operative recovery. It is also essential to preserve the splenic artery and vein. Large randomized controlled trials are further needed to verify the results of this meta-analysis.
References
[1]
Mellemkjaer L, Olsen JH, Linet MS, Gridley G, McLaughlin JK (1995) [Cancer risk after splenectomy]. Ugeskr Laeger 157: 5097–5100.
[2]
Bonenkamp J, Songun I, Welvaart K, van de Velde C, Hermans J, et al. (1995) Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. The Lancet 345: 745–748. doi: 10.1016/s0140-6736(95)90637-1
[3]
McGory ML, Zingmond DS, Sekeris E, Ko CY (2007) The significance of inadvertent splenectomy during colorectal cancer resection. Archives of Surgery 142: 668. doi: 10.1001/archsurg.142.7.668
[4]
Espat NJ (2003) History of the Pancreas: Mysteries of a Hidden Organ. JAMA: The Journal of the American Medical Association 289: 1862–1863. doi: 10.1001/jama.289.14.1862
[5]
Mallet-Guy P, Vachon A (1943) Pancreatites Chroniques Gauches: Paris.
[6]
Laxa BU, Carbonell AM, Cobb WS, Rosen MJ, Hardacre JM, et al. (2008) Laparoscopic and hand-assisted distal pancreatectomy. The American Surgeon 74: 481–487.
[7]
Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, et al. (2007) Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Annals of surgery 246: 77. doi: 10.1097/01.sla.0000258607.17194.2b
[8]
Cooper M, Williamson R (1985) Conservative pancreatectomy. British journal of surgery 72: 801–803. doi: 10.1002/bjs.1800721009
[9]
Amit Khanna MD M, Koniaris LG, Schoeniger LO (2005) Laparoscopic spleen-preserving distal pancreatectomy. Journal of gastrointestinal surgery 9: 733–738. doi: 10.1016/j.gassur.2004.07.006
[10]
Dulucq J, Wintringer P, Stabilini C, Feryn T, Perissat J, et al. (2005) Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surgical Endoscopy And Other Interventional Techniques 19: 1028–1034. doi: 10.1007/s00464-004-2182-7
[11]
Edwin B, Mala T, Mathisen U？, Gladhaug I, Buanes T, et al. (2004) Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surgical Endoscopy and Other Interventional Techniques 18: 407–411. doi: 10.1007/s00464-003-9007-y
[12]
Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, et al. (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137: 597–605. doi: 10.1016/j.surg.2005.02.002
[13]
Benoist S, Dugué L, Sauvanet A, Valverde A, Mauvais F, et al. (1999) Is there a role of preservation of the spleen in distal pancreatectomy? Journal of the American College of Surgeons 188: 255–260. doi: 10.1016/s1072-7515(98)00299-3
[14]
Carrère N, Abid S, Julio CH, Bloom E, Pradère B (2007) Spleen-preserving distal pancreatectomy with excision of splenic artery and vein: a case-matched comparison with conventional distal pancreatectomy with splenectomy. World journal of surgery 31: 375–382. doi: 10.1007/s00268-006-0425-6
[15]
Choi SH, Seo MA, Hwang HK, Kang CM, Lee WJ (2012) Is it worthwhile to preserve adult spleen in laparoscopic distal pancreatectomy? Perioperative and patient-reported outcome analysis. Surgical endoscopy 26: 3149–3156. doi: 10.1007/s00464-012-2306-4
[16]
Feng W, Tang C, Bao Y, Fei M, Tao Y (2013) Spleen-preserving Distal Pancreatectomy: Perioperative and Long-term Outcome Analysis. Hepato-gastroenterology 60.
[17]
Ma J, Chen C, Peng L, Zhao G, Cai S, et al. (2011) Spleen-preserving distal pancreatectomy with conservation of the spleen vessels. Chinese Medical Journal-Beijing 124: 1217.
Richardson D, Scott-Conner C (1989) Distal pancreatectomy with and without splenectomy. A comparative study. The American surgeon 55: 21–25.
[20]
Rodríguez JR, Madanat MG, Healy BC, Thayer SP, Warshaw AL, et al. (2007) Distal pancreatectomy with splenic preservation revisited. Surgery 141: 619–625. doi: 10.1016/j.surg.2006.09.020
[21]
Shoup M, Brennan MF, McWhite K, Leung DH, Klimstra D, et al. (2002) The value of splenic preservation with distal pancreatectomy. Archives of surgery 137: 164. doi: 10.1016/s0016-5085(01)82403-3
[22]
Yamaguchi K, Noshiro H, Yokohata K, Nakano K, Watanabe M, et al. (2001) Is there any benefit of preservation of the spleen in distal pancreatectomy? International surgery 86: 162–168.
[23]
Zhao Y, Du X, Dai M, Zhang T, Liao Q, et al. (2012) Laparoscopic distal pancreatectomy with or without splenectomy: spleen-preservation does not increase morbidity. Hepatobiliary & Pancreatic Diseases International 11: 536–541. doi: 10.1016/s1499-3872(12)60220-3
[24]
Warshaw AL (1988) Conservation of the spleen with distal pancreatectomy. Archives of Surgery 123: 550. doi: 10.1001/archsurg.1988.01400290032004
[25]
Tsiouris A, Cogan CM, Velanovich V (2011) Distal pancreatectomy with or without splenectomy: comparison of postoperative outcomes and surrogates of splenic function. HPB 13: 738–744. doi: 10.1111/j.1477-2574.2011.00369.x
[26]
Lee SE, Jang JY, Lee KU, Kim SW (2008) Clinical comparison of distal pancreatectomy with or without splenectomy. Journal of Korean medical science 23: 1011–1014. doi: 10.3346/jkms.2008.23.6.1011
[27]
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, et al. (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138: 8–13. doi: 10.1016/j.surg.2005.05.001
[28]
Martin FM, Rossi RL, Munson JL, ReMine SG, Braasch JW (1989) Management of pancreatic fistulas. Archives of Surgery 124: 571. doi: 10.1001/archsurg.1989.01410050061012
[29]
Montorsi M, Zago M, Mosca F, Capussotti L, Zotti E, et al. (1995) Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized clinical trial. Surgery 117: 26–31. doi: 10.1016/s0039-6060(05)80225-9
Lynch AM, Kapila R (1996) Overwhelming postsplenectomy infection. Infectious disease clinics of North America 10: 693–707. doi: 10.1016/s0891-5520(05)70322-6
[32]
Mellemkj？er L, Olsen JRH, Linet MS, Gridley G, McLaughlin JK (1995) Cancer risk after splenectomy. Cancer 75: 577–583. doi: 10.1002/1097-0142(19950115)75:2<577::aid-cncr2820750222>3.0.co;2-k
[33]
Norman M (2012) Distal Pancreatectomy with Spleen Preservation. Should it be the Norm? Journal of Pancreatic Disorders & Therapy.
