Splenic preserving distal pancreatectomy: Does vessel preservation matter?

Joal D. Beane, Henry A. Pitt, Attila Nakeeb, C. Schmidt, Michael House, Nicholas Zyromski, Thomas Howard, Keith D. Lillemoe

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Background: Splenic preserving distal pancreatectomy (SPDP) can be accomplished with splenic artery and vein preservation or ligation. However, no data are available on the relative merits of these techniques. The aim of this analysis was to compare the outcomes of splenic preserving distal pancreatectomy with and without splenic vessel preservation. Study Design: From 2002 through 2009, 434 patients underwent distal pancreatectomy and 86 (20%) had splenic preservation. Vessel preservation (VP) was accomplished in 45 and ligation (VL) was performed in 41. These patients were similar with respect to age, American Society of Anesthesiologists class, pathology, surgeons, and minimally invasive approach (79%). For comparison, a matched group of 86 patients undergoing distal pancreatectomy with splenectomy (DP+S) was analyzed. Results: The VP-SPDP procedure was associated with less blood loss than VL-SPDP or DP+S (224 vs 508 vs 646 mL, respectively; p < 0.05). The VP-SPDP procedure also resulted in fewer grade B or C pancreatic fistulas (2% vs 12% vs 14%; p = NS) and splenic infarctions (5% vs 39%; p < 0.01), less overall morbidity (18% vs 39% vs 38%, respectively; p < 0.05) and need for drainage procedure (2% vs 15% vs 16%; p < 0.05), and shorter post-operative length of stay (4.5 vs 6.2 vs 6.6 days; p < 0.05). Conclusions: This analysis suggests that outcomes are (1) best for VP-SPDP and (2) VL-SPDP provides no short-term advantage over distal pancreatectomy with splenectomy. We conclude that splenic VP is preferred when SPDP is performed.

Original languageEnglish
Pages (from-to)651-657
Number of pages7
JournalJournal of the American College of Surgeons
Volume212
Issue number4
DOIs
StatePublished - Apr 2011

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Pancreatectomy
Splenectomy
Ligation
Splenic Infarction
Splenic Vein
Pancreatic Fistula
Splenic Artery
Drainage
Length of Stay
Research Design
Pathology
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Splenic preserving distal pancreatectomy : Does vessel preservation matter? / Beane, Joal D.; Pitt, Henry A.; Nakeeb, Attila; Schmidt, C.; House, Michael; Zyromski, Nicholas; Howard, Thomas; Lillemoe, Keith D.

In: Journal of the American College of Surgeons, Vol. 212, No. 4, 04.2011, p. 651-657.

Research output: Contribution to journalArticle

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abstract = "Background: Splenic preserving distal pancreatectomy (SPDP) can be accomplished with splenic artery and vein preservation or ligation. However, no data are available on the relative merits of these techniques. The aim of this analysis was to compare the outcomes of splenic preserving distal pancreatectomy with and without splenic vessel preservation. Study Design: From 2002 through 2009, 434 patients underwent distal pancreatectomy and 86 (20{\%}) had splenic preservation. Vessel preservation (VP) was accomplished in 45 and ligation (VL) was performed in 41. These patients were similar with respect to age, American Society of Anesthesiologists class, pathology, surgeons, and minimally invasive approach (79{\%}). For comparison, a matched group of 86 patients undergoing distal pancreatectomy with splenectomy (DP+S) was analyzed. Results: The VP-SPDP procedure was associated with less blood loss than VL-SPDP or DP+S (224 vs 508 vs 646 mL, respectively; p < 0.05). The VP-SPDP procedure also resulted in fewer grade B or C pancreatic fistulas (2{\%} vs 12{\%} vs 14{\%}; p = NS) and splenic infarctions (5{\%} vs 39{\%}; p < 0.01), less overall morbidity (18{\%} vs 39{\%} vs 38{\%}, respectively; p < 0.05) and need for drainage procedure (2{\%} vs 15{\%} vs 16{\%}; p < 0.05), and shorter post-operative length of stay (4.5 vs 6.2 vs 6.6 days; p < 0.05). Conclusions: This analysis suggests that outcomes are (1) best for VP-SPDP and (2) VL-SPDP provides no short-term advantage over distal pancreatectomy with splenectomy. We conclude that splenic VP is preferred when SPDP is performed.",
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