Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA; Department of Surgery, Lihuili Eastern Hospital, Ningbo, China.
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
Int J Surg. 2017 Sep;45:47-55. doi: 10.1016/j.ijsu.2017.07.078. Epub 2017 Jul 21.
Distal pancreatectomy (DP) is performed to treat tumors of the pancreatic body and tail. Traditionally, splenectomy is performed with a DP, however, laparoscopic spleen-preserving DP (SPDP) using Warshaw's (splenic vessels ligation) or Kimura's (splenic vessels preservation) techniques have been reported. The clinical benefits of using either technique remain unclear. In this study, we conducted a meta-analysis to compare the clinical outcomes of patients undergoing Warshaw's and Kimura SPDP. This is the first study to evaluate the geographical variation in outcomes of Warshaw's and Kimura SPDP.
Databases of PubMed, Embase, and Cochrane library were used to identify studies reporting Warshaw's and Kimura SPDP. Clinical outcomes were compared. Pooled odds risk and weighted mean difference with 95% confidence interval were calculated using random effect models.
Fourteen non-randomized controlled studies involving 945 patients met our selection criteria. 301 (31.9%) patients underwent Warshaw's SPDP; 644 (68.1%) underwent Kimura SPDP. Compared to Warshaw's SPDP, patients undergoing Kimura SPDP had a lower incidence of post-operative complications including spleen infarction (OR = 9.64, 95% CI = 5.79 to 16.05, P < 0.001) and gastric varices (OR = 11.88, 95% CI = 5.11 to 27.66, P < 0.001). The length of surgery was significantly shorter for Warshaw's SPDP (WMD = -18.12, 95%CI = -26.52 to -9.72, p < 0.001). Decreased blood loss was reported for patients undergoing Warshaw's SPDP (WMD = -59.72, 95%CI = -102.01 to -17.43, p = 0.006). There were no differences between the two groups' rates of conversion to an open procedure (P = 0.35), postoperative pancreatic fistula (P = 0.71), need for reoperation (P = 0.25), and length of hospital stay (P = 0.38).
Both Warshaw's and Kimura are safe SPDP techniques. These data suggest Kimura SPDP is the preferred technique due to less risk of splenic infarct and gastric varices. Despite evidence of regional variation in volume performed (between Kimura and Warshaw's), there are no statistically significant differences in outcomes between these techniques.
胰体尾部肿瘤行胰体尾部切除术（DP）。传统上 DP 联合脾切除术，但 Warshaw （结扎脾血管）或 Kimura （保留脾血管）技术的腹腔镜保脾 DP（SPDP）已经有报道。两种技术的临床获益仍不清楚。本研究进行了荟萃分析比较两种技术的临床结局。这是第一项评估 Warshaw 和 Kimura SPDP 结局地理差异的研究。
PubMed、Embase 和 Cochrane 图书馆数据库用于确定报道 Warshaw 和 Kimura SPDP 的研究。比较临床结局。使用随机效应模型计算合并比值比和加权均数差及 95%置信区间。
纳入符合条件的 14 项非随机对照研究共 945 例患者。301 例（31.9%）行 Warshaw SPDP，644 例（68.1%）行 Kimura SPDP。与 Warshaw SPDP 相比，Kimura SPDP 术后并发症发生率较低，包括脾梗死（OR=9.64，95%CI=5.79 至 16.05，P<0.001）和胃静脉曲张（OR=11.88，95%CI=5.11 至 27.66，P<0.001）。Warshaw SPDP 的手术时间显著缩短（WMD=-18.12，95%CI=-26.52 至-9.72，P<0.001）。报道 Warshaw SPDP 术中失血量减少（WMD=-59.72，95%CI=-102.01 至-17.43，P=0.006）。两组中转开腹率（P=0.35）、术后胰瘘（P=0.71）、再次手术率（P=0.25）和住院时间（P=0.38）差异无统计学意义。
Warshaw 和 Kimura 都是安全的 SPDP 技术。这些数据表明，由于脾梗死和胃静脉曲张的风险较低，Kimura SPDP 是首选技术。尽管在手术量上存在区域差异（Kimura 和 Warshaw 之间），但两种技术的结局无统计学差异。
