Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital, Cracow, Poland.
Department of Pathomorphology, Jagiellonian University Medical College, Cracow, Poland.
Surg Laparosc Endosc Percutan Tech. 2024 Oct 1;34(5):497-503. doi: 10.1097/SLE.0000000000001309.
Spleen preservation during laparoscopic distal pancreatectomy (LSPDP) should be pursued if safe and oncologically justified. The aim of the presented study was to compare surgical outcomes and identify risk factors for unplanned splenectomy during laparoscopic distal pancreatectomy and evaluate short and long-terms outcomes.
The following study is a retrospective cohort study of consecutive patients who underwent laparoscopic distal pancreatectomy, with the intention of preserving the spleen, for benign tumors of the body and tail of the pancreas between August 2012 and December 2022. Follow-up for patients' survival was completed in January 2023. In all, 106 patients were in total included in this study. Median age was 58 (41 to 67) years. The study population included 29 males (27.4%) and 77 females (72.6%).
Spleen preservation was possible in 67 (63.2%) patients. The tumor size was larger in the splenectomy group (respectively, 30 (16.5 to 49) vs. 15 (11 to 25); P <0.001). Overall, serious postoperative morbidity was 13.4% in the LSPDP group and 20.5% in the second group ( P =0.494). There were no perioperative deaths. The postoperative pancreatic fistula rate was 18% in the splenectomy group and 14.9% in the LSPDP group, while B and C fistulas were diagnosed in 15.4% and 10.5% of patients, respectively. In the multivariate logistic regression model, tumor size >3 cm was found to independently increase odds for unplanned splenectomy (OR 8.41, 95%CI 2.89-24.46; standardized for BMI).
Unplanned splenectomy during the attempt of LSPDP does not increase the risk for postoperative morbidity and postoperative pancreatic fistula. The independent risk factor for unplanned splenectomy during LSPDP is tumor size above 3 cm.
腹腔镜胰体尾切除术（LSPDP）时如果安全且符合肿瘤学要求，应保留脾脏。本研究的目的是比较手术结果，确定腹腔镜胰体尾切除术时计划外脾切除术的危险因素，并评估短期和长期结果。
本研究是一项回顾性队列研究，纳入 2012 年 8 月至 2022 年 12 月期间因胰腺体尾部良性肿瘤行腹腔镜胰体尾切除术且有保留脾脏意愿的连续患者。截至 2023 年 1 月，完成了患者生存随访。共纳入 106 例患者。中位年龄为 58（41 至 67）岁。研究人群包括 29 名男性（27.4%）和 77 名女性（72.6%）。
67 例（63.2%）患者成功保留脾脏。脾切除术组的肿瘤更大（分别为 30（16.5 至 49）与 15（11 至 25）；P<0.001）。总体而言，LSPDP 组的严重术后发病率为 13.4%，而第二组为 20.5%（P=0.494）。无围手术期死亡。脾切除术组的术后胰瘘发生率为 18%，LSPDP 组为 14.9%，分别有 15.4%和 10.5%的患者诊断为 B 和 C 型瘘。在多变量逻辑回归模型中，肿瘤大小>3cm 被发现是计划外脾切除术的独立危险因素（比值比 8.41，95%置信区间 2.89-24.46；标准化体重指数）。
LSPDP 时计划外脾切除术不会增加术后发病率和术后胰瘘的风险。LSPDP 时计划外脾切除术的独立危险因素是肿瘤大小>3cm。
