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Meta-Analysis
. 2014 Mar 28;9(3):e91593.
doi: 10.1371/journal.pone.0091593. eCollection 2014.

Clinical comparison of distal pancreatectomy with or without splenectomy: a meta-analysis

Zhigang He  1 , Daohai Qian  1 , Jie Hua  1 , Jian Gong  1 , Shengping Lin  1 , Zhenshun Song  1
Affiliations
Meta-Analysis

Clinical comparison of distal pancreatectomy with or without splenectomy: a meta-analysis

Zhigang He et al. PLoS One. .

Erratum in

  • PLoS One. 2014;9(7):e103464

Abstract

Objective: A distal pancreatectomy has routinely been used for removing benign/borderline malignant tumors of the body and tail of the pancreas; however, controversy exists whether or not the spleen should be saved. Therefore, we conducted this meta-analysis for comparing the clinical outcomes of patients who underwent distal pancreatectomy with or without splenectomy.

Methods: A literature research from the databases of Medline, Embase, and Cochrane library was performed to evaluate and compare the clinical outcomes between spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS). Pooled odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (95% CI) were calculated using fixed-effects or random-effects models.

Results: Eleven non-randomized controlled studies involving 897 patients were selected to satisfy the inclusion criteria; 355 patients underwent SPDP and 542 patients underwent DPS. Compared with DPS, SPDP required a shorter hospital stay (WMD = 1.16, 95% CI = -2.00 to -0.31, P = 0.007), and had a lower incidence of intra-abdominal abscesses (OR = 0.48, 95% CI = 0.27 to 0.83, P = 0.009). In addition, spleen infarctions occurred in SPDP, most of which involved use of the Warshaw method for preserving the spleen. There were no differences between the SPDP and DPS groups with respect to operative time, operative blood loss, requirement for blood transfusion, pancreatic fistulas, thromboses, post-operative bleeding, wound infections and re-operation rates.

Conclusion: SPDP should be performed due to the benefits of the immune system and quick post-operative recovery. It is also essential to preserve the splenic artery and vein. Large randomized controlled trials are further needed to verify the results of this meta-analysis.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow diagram of our method of evidence.
Figure 2
Figure 2. Operative time (min) (IV, Inverse variance, M-H, Mantel-Haenszel, CI, Confidence Interval; SD, Standard deviation).
Figure 3
Figure 3. Estimated blood loss (IV, Inverse variance, M-H, Mantel-Haenszel, CI, Confidence Interval; SD, Standard deviation).
Figure 4
Figure 4. Transfusion requirement (IV, Inverse variance, M-H, Mantel-Haenszel, CI, Confidence Interval; SD, Standard deviation).
Figure 5
Figure 5. Pancreatic fistula (IV, Inverse variance; M-H, Mantel-Haenszel; CI, Confidence Interval; SD, standard deviation).
Figure 6
Figure 6. Wound infection (IV, Inverse variance; M-H, Mantel-Haenszel; CI, Confidence Interval; SD, standard deviation).
Figure 7
Figure 7. Intra-abdominal abscess (IV, Inverse variance; M-H, Mantel-Haenszel; CI, Confidence Interval; SD, standard deviation).
Figure 8
Figure 8. Postoperative bleeding (IV, Inverse variance; M-H, Mantel-Haenszel; CI, Confidence Interval; SD, standard deviation).
Figure 9
Figure 9. Thrombosis (IV, Inverse variance; M-H, Mantel-Haenszel; CI, Confidence Interval; SD, standard deviation).
Figure 10
Figure 10. Re-operation (IV, Inverse variance; M-H, Mantel-Haenszel; CI, Confidence Interval; SD, standard deviation).
Figure 11
Figure 11. Postoperative LoS (days) (IV, Inverse variance; M-H, Mantel-Haenszel; CI, Confidence Interval; SD, standard deviation).
Figure 12
Figure 12. Funnel plots of postoperative bleeding.
OR odds ratio; SE (log [OR]): standard error of the natural logarithm of the odds ratio.
See this image and copyright information in PMC

References

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