Timmerhuis Hester C, Ngongoni Rejoice F, Jensen Christopher W, Baiocchi Michael, DeLong Jonathan C, Dua Monica M, Norton Jeffrey A, Poultsides George A, Worth Patrick J, Visser Brendan C
Department of Surgery, Section of Hepatobiliary Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
J Gastrointest Surg. 2023 Oct;27(10):2166-2176. doi: 10.1007/s11605-023-05809-3. Epub 2023 Aug 31.
Spleen-preservation during minimally invasive distal pancreatectomy (MIDP) can be technically challenging and remains controversial. Our primary aim was to compare MIDP and splenectomy with spleen-preserving MIDP. Secondarily, we compared two spleen-preserving techniques.
Adults undergoing MIDP (2007-2021) were retrospectively included in this single-center study. Intraoperative and postoperative outcomes between spleen-preservation and splenectomy and between the two spleen-preserving techniques were compared using the Mann-Whitney U test for continuous data, and Fisher's exact test for categorical data.
Of the 293 patients who underwent MIDP, preservation of the spleen was intended in 208 (71%) patients. Spleen-preservation was achieved in 174 patients (84%) via the Warshaw technique (130; 75%) or vessel-preservation (44; 25%). The spleen-preserving group had shorter length of stay (3 vs 4 days, p < 0.01), fewer conversions to open (1 vs 12, p < 0.01) and less blood loss (p < 0.01) compared to the splenectomy group. Operative (OR) times were comparable (229 vs 214 min, p = 0.67). Except for the operative time, which was longer for the Warshaw technique (245 vs 183 min, p = 0.01), no other differences between the two spleen-preserving techniques were found. At a median follow-up of 43 (IQR 18-79) months after spleen-preservation, only 2 (1.1%) patients had required splenectomy (1 partial splenectomy for infarct/abscess after Warshaw, 1 for variceal bleeding after vessel-preserving).
Spleen-preservation is not associated with increased risk of blood loss, longer hospital stay, conversion, nor lengthy OR times. Late splenectomy is very rarely required. Given the immune consequences of splenectomy, spleen-preservation should be strongly considered in MIDP.
在微创远端胰腺切除术（MIDP）中保留脾脏在技术上具有挑战性，并且仍存在争议。我们的主要目的是比较MIDP联合脾切除术与保留脾脏的MIDP。其次，我们比较了两种保留脾脏的技术。
回顾性纳入本单中心研究中2007年至2021年接受MIDP的成年人。使用Mann-Whitney U检验比较保留脾脏组与脾切除组之间以及两种保留脾脏技术之间的术中及术后结果，连续数据采用Mann-Whitney U检验，分类数据采用Fisher精确检验。
在293例行MIDP的患者中，208例（71%）患者打算保留脾脏。174例（84%）患者通过Warshaw技术（130例；75%）或保留血管技术（44例；25%）成功保留了脾脏。与脾切除组相比，保留脾脏组的住院时间更短（3天对4天，p<0.01），转为开腹手术的例数更少（1例对12例，p<0.01），失血量更少（p<0.01）。手术时间相当（229分钟对214分钟，p=0.67）。除了Warshaw技术的手术时间更长（245分钟对183分钟，p=0.01）外，两种保留脾脏技术之间未发现其他差异。在保留脾脏后中位随访43（IQR 18 - 79）个月时，仅2例（1.1%）患者需要行脾切除术（1例因Warshaw术后梗死/脓肿行部分脾切除术，1例因保留血管术后静脉曲张出血行脾切除术）。
保留脾脏与失血量增加、住院时间延长、转为开腹手术或手术时间延长的风险无关。很少需要晚期脾切除术。鉴于脾切除的免疫后果，在MIDP中应强烈考虑保留脾脏。
