Minimally invasive spleen-preserving distal pancreatectomy: Does splenic vessel preservation have better postoperative outcomes? A systematic review and meta-analysis
Fady Elabbasy, Rahul Gadde, Mena M Hanna, Danny Sleeman, Alan Livingstone and Danny Yakoub
Miami, USA
Author Affiliations: Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Miami, Florida, USA (Elabbasy F, Gadde R, Hanna MM, Sleeman D, Livingstone A and Yakoub D)
Corresponding Author: Danny Yakoub, MD, PhD, Division of Surgical Oncology, University of Miami-Miller School of Medicine, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, 1120 NW 14th Street, CRB C232, Miami, Florida 33136, USA (Tel: +305-243-4902; Fax: +305-243-4907; Email: dyakoub@med.miami.edu)
BACKGROUND: Minimally invasive spleen-preserving distal pancreatectomy (SPDP) can be performed with either splenic vessel preservation (SVP) or resection [Warshaw procedure (WP)]. The aim of this study was to evaluate the postoperative clinical outcomes of patients undergoing both methods.
DATA SOURCES: Database search of PubMed, Embase, Scopus, Cochrane, and Google Scholar was performed (2000-2014); key bibliographies were reviewed. Qualified studies comparing patients undergoing SPDP with either SVP or WP, and assessing postoperative complications were included. Calculated pooled risk ratio (RR) with the corresponding 95% confidence interval (CI) by random effects methods were used in the meta-analyses.
RESULTS: The search yielded 215 studies, of which only 14 observational studies met our selection criteria. The studies included 943 patients in total; 652 (69%) underwent SVP and 291 (31%) underwent WP. Overall, there was a lower incidence of splenic infarction (RR=0.17; 95% CI: 0.09-0.33; P<0.001), gastric varices (RR=0.16; 95% CI: 0.05-0.51; P=0.002), and intra/postoperative splenectomy (RR=0.20; 95% CI: 0.08-0.49; P<0.001) in the SVP group. There was no difference in incidence of pancreatic fistula (WP vs SVP, 23.6% vs 22.9%; P=0.37), length of hospital stay, operative time or blood loss. There was moderate cross-study heterogeneity.
CONCLUSIONS: SVP is a safe, efficient and feasible technique that may be used to preserve the spleen. WP may be more suitable for large tumors close to the splenic hilum or those associated with splenomegaly. Randomized clinical trials are justified to examine the long-term benefits of SVP-SPDP.
2015, Vol. 14 
