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, Danny Yakoub

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background Minimally invasive spleen-preserving distal pancreatectomy (SPDP) can be performed with either splenic vessel preservation (SVP) or resection [Warshaw procedure (WP)"10". 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.

Original languageEnglish (US)
Pages (from-to)346-353
Number of pages8
JournalHepatobiliary and Pancreatic Diseases International
Volume14
Issue number4
DOIs
StatePublished - Aug 15 2015

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Pancreatectomy
Meta-Analysis
Spleen
Odds Ratio
Confidence Intervals
Length of Stay
Splenic Infarction
Pancreatic Fistula
Esophageal and Gastric Varices
Information Storage and Retrieval
Splenomegaly
Incidence
Bibliography
Splenectomy
Operative Time
PubMed
Patient Selection
Observational Studies
Randomized Controlled Trials
Databases

Keywords

  • gastric varices
  • spleen-preserving distal pancreatectomy
  • splenic infarction
  • splenic vessel preservation
  • Warshaw procedure

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

@article{15891a77877b40e0889fc2f56330b44a,
title = "Minimally invasive spleen-preserving distal pancreatectomy: Does splenic vessel preservation have better postoperative outcomes? A systematic review and meta-analysis",
abstract = "Background Minimally invasive spleen-preserving distal pancreatectomy (SPDP) can be performed with either splenic vessel preservation (SVP) or resection [Warshaw procedure (WP){"}10{"}. 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.",
keywords = "gastric varices, spleen-preserving distal pancreatectomy, splenic infarction, splenic vessel preservation, Warshaw procedure",
author = "Fady Elabbasy and Rahul Gadde and Hanna, {Mena M.} and Danny Sleeman and Alan Livingstone and Danny Yakoub",
year = "2015",
month = "8",
day = "15",
doi = "10.1016/S1499-3872(15)60399-X",
language = "English (US)",
volume = "14",
pages = "346--353",
journal = "Hepatobiliary and Pancreatic Diseases International",
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T1 - Minimally invasive spleen-preserving distal pancreatectomy

T2 - Does splenic vessel preservation have better postoperative outcomes? A systematic review and meta-analysis

AU - Elabbasy, Fady

AU - Gadde, Rahul

AU - Hanna, Mena M.

AU - Sleeman, Danny

AU - Livingstone, Alan

AU - Yakoub, Danny

PY - 2015/8/15

Y1 - 2015/8/15

N2 - Background Minimally invasive spleen-preserving distal pancreatectomy (SPDP) can be performed with either splenic vessel preservation (SVP) or resection [Warshaw procedure (WP)"10". 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.

AB - Background Minimally invasive spleen-preserving distal pancreatectomy (SPDP) can be performed with either splenic vessel preservation (SVP) or resection [Warshaw procedure (WP)"10". 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.

KW - gastric varices

KW - spleen-preserving distal pancreatectomy

KW - splenic infarction

KW - splenic vessel preservation

KW - Warshaw procedure

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