Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
Surgeon. 2024 Feb;22(1):e13-e25. doi: 10.1016/j.surge.2023.08.006. Epub 2023 Sep 4.
To evaluate comparative outcomes of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and laparoscopic distal pancreatectomy with splenectomy (LDPS).
A systematic search of multiple electronic data sources and bibliographic reference lists were conducted. Comparative studies reporting outcomes of LSPDP and LDPS were considered followed by evaluation of the associated risk of bias according to ROBINS-I tool. Perioperative complications, clinically important postoperative pancreatic fistula (POPF), infectious complications, blood loss, conversion to open, operative time and duration of hospital stay were the investigated outcome parameters.
Nineteen studies were identified enrolling 3739 patients of whom 1860 patients underwent LSPDP and the remaining 1879 patients had LDPS. The patients in the LSPDP and LDPS groups were of comparable age (p = 0.73), gender (p = 0.59), and BMI (p = 0.07). However, the patient in the LDPS group had larger tumour size (p = 0.0004) and more malignant lesions (p = 0.02). LSPDP was associated with significantly lower POPF (OR:0.65, p = 0.02), blood loss (MD:-28.30, p = 0.001), and conversion to open (OR:0.48, p < 0.0001) compared to LDPS. Moreover, it was associated with significantly shorter procedure time (MD: -22.06, p = 0.0009) and length of hospital stay (MD: -0.75, p = 0.005). However, no significant differences were identified in overall perioperative (OR:0.89, p = 0.25) or infectious (OR:0.67, p = 0.05) complications between two groups.
LSPDP seems to be associated with lower POPF, bleeding and conversion to open compared to LDPS in patients with small-sized benign tumours. Moreover, it may be quicker and reduce hospital stay. Nevertheless, such advantages are of doubtful merit about large-sized or malignant tumours. The available evidence is subject to confounding by indication.
评估保留脾脏的腹腔镜胰体尾部切除术（LSPDP）与腹腔镜胰体尾部切除术联合脾脏切除术（LDPS）的对比结果。
系统检索了多个电子数据库和文献参考列表。根据 ROBINS-I 工具评估相关偏倚风险后，纳入报告 LSPDP 和 LDPS 结果的对照研究。研究的观察指标包括围手术期并发症、临床意义重大的术后胰瘘（POPF）、感染并发症、出血量、中转开腹、手术时间和住院时间。
共确定了 19 项研究，共纳入 3739 例患者，其中 1860 例患者接受了 LSPDP，其余 1879 例患者接受了 LDPS。LSPDP 和 LDPS 组患者的年龄（p=0.73）、性别（p=0.59）和 BMI（p=0.07）相当。然而，LDPS 组患者的肿瘤更大（p=0.0004），且恶性病变更多（p=0.02）。与 LDPS 相比，LSPDP 术后 POPF（OR：0.65，p=0.02）、出血量（MD：-28.30，p=0.001）和中转开腹（OR：0.48，p<0.0001）发生率显著降低。此外，LSPDP 手术时间（MD：-22.06，p=0.0009）和住院时间（MD：-0.75，p=0.005）更短。然而，两组患者的总体围手术期（OR：0.89，p=0.25）或感染性（OR：0.67，p=0.05）并发症发生率无显著差异。
对于小尺寸良性肿瘤患者，LSPDP 与 LDPS 相比，POPF、出血和中转开腹的发生率更低，手术速度更快，住院时间更短。然而，对于大尺寸或恶性肿瘤，这种优势可能值得怀疑。现有证据易受混杂因素的影响。
