Kwon Wooil, Jang Jin-Young, Kim Jung Hoon, Chang Ye Rim, Jung Woohyun, Kang Mee Joo, Kim Sun-Whe
1 Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine , Seoul, Korea.
2 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea.
J Laparoendosc Adv Surg Tech A. 2016 May;26(5):335-42. doi: 10.1089/lap.2015.0171. Epub 2016 Mar 16.
Whether splenectomy is adverse or spleen preservation offers significant advantages in distal pancreatic resection is unclear. The aim was to compare the early/late clinical results and the functional outcomes in terms of quality of life (QoL) and nutrition between conventional laparoscopic distal pancreatectomy (LDP) and laparoscopic spleen-preserving distal pancreatectomy (LSPDP).
Clinical data and computed tomography findings of 111 laparoscopic distal resections (79 LDPs and 32 LSPDPs) between 1999 and 2012 were retrospectively reviewed. QoL was assessed by the EORTC QLQ-C30. Body mass index and biochemical tests were examined as nutritional indices. Comparative analysis was done.
The mean follow-up was 25 months. The operation time was shorter in LSPDP (127.9 minutes vs. 158.0 minutes, P < .001). The lesion size was larger in LDP (36.8 mm vs. 27.2 mm, P < .01). Mucinous cystic neoplasm (MCN) was the most common diagnosis in LDP and intraductal papillary mucinous neoplasm (IPMN) in LSPDP. Early results showed similar hospital days and infection episodes. Nonvascular complications were more frequent in LDP owing to more fluid collections (43.0% vs. 21.9%, P = .04). The ISGPF grade B/C pancreatic fistula rates were similar (27.8% in LDP vs. 25.0% in LSPDP, P = .760). Vascular complications were more frequent in LSPDP (64.5% vs. 26.0%, P < .01). Excluding some fluid collections, none required a specific treatment. Late results demonstrated no differences in nonvascular results. Vascular complications were more frequent in LSPDP (65.6% vs. 4.2%, P < .01). The vascular complications did not require any specific treatment or have any serious sequelae. There was no overwhelming postsplenectomy infection. QoL and nutritional indices showed no difference. QoL decreased at discharge and recovered from 3 months thereafter. Nutritional indices showed a similar pattern.
LDP is associated with more fluid collections and LSPDP with more vascular complications, all with a minimal clinical impact. Both methods had similar functional outcomes. Either LDP or LSPDP could be performed depending on the indication and surgeon's experiences considering the comparable results.
在胰体尾切除术（distal pancreatic resection）中，脾切除术是否不利或保留脾脏是否具有显著优势尚不清楚。目的是比较传统腹腔镜胰体尾切除术（LDP）和腹腔镜保留脾脏的胰体尾切除术（LSPDP）在早期/晚期临床结果以及生活质量（QoL）和营养方面的功能结局。
回顾性分析了1999年至2012年间111例腹腔镜胰体尾切除术（79例LDP和32例LSPDP）的临床资料和计算机断层扫描结果。通过欧洲癌症研究与治疗组织核心生活质量问卷（EORTC QLQ-C30）评估生活质量。将体重指数和生化检查作为营养指标进行检测，并进行比较分析。
平均随访时间为25个月。LSPDP的手术时间较短（127.9分钟对158.0分钟，P <.001）。LDP的病变尺寸较大（36.8mm对27.2mm，P <.01）。黏液性囊性肿瘤（MCN）是LDP中最常见的诊断，而导管内乳头状黏液性肿瘤（IPMN）是LSPDP中最常见的诊断。早期结果显示住院天数和感染发生率相似。由于积液更多，LDP的非血管并发症更常见（43.0%对21.9%，P = 0.04）。国际胰腺外科研究小组（ISGPF）B/C级胰瘘发生率相似（LDP中为27.8%，LSPDP中为25.0%，P = 0.760）。LSPDP的血管并发症更常见（64.5%对26.0%，P <.01）。除了一些积液外，均无需特殊治疗。晚期结果显示非血管方面的结果无差异。LSPDP的血管并发症更常见（65.6%对4.2%，P <.01）。这些血管并发症无需任何特殊治疗，也没有任何严重后遗症。没有出现严重的脾切除术后感染。生活质量和营养指标无差异。出院时生活质量下降，此后3个月恢复。营养指标呈现类似模式。
LDP与更多的积液相关，LSPDP与更多的血管并发症相关，所有这些对临床影响最小。两种方法的功能结局相似。考虑到结果相当，可根据适应症和外科医生的经验选择进行LDP或LSPDP。
