. 2020 Mar;34(3):1301-1309.

doi: 10.1007/s00464-019-06901-z. Epub 2019 Jun 24.

Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study

Affiliations

¹ Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 2YD, UK. a.l.moekotte@soton.ac.uk.
² Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 2YD, UK.
³ Department of Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
⁴ Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
⁵ Department of Surgery, Morriston Hospital, Swansea, UK.
⁶ Department of Surgery, Royal Free London NHS Foundation Trust, London, UK.
⁷ Department of Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁸ Department of Surgery, Royal Stoke University Hospital, Stoke, UK.
⁹ Department of Surgery, Plymouth Hospitals NHS Trust, Plymouth, UK.
¹⁰ Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
¹¹ Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹² Department of Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.

PMID: 31236723
PMCID: PMC7012970
DOI: 10.1007/s00464-019-06901-z

Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study

Alma L Moekotte et al. Surg Endosc. 2020 Mar.

. 2020 Mar;34(3):1301-1309.

doi: 10.1007/s00464-019-06901-z. Epub 2019 Jun 24.

Affiliations

¹ Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 2YD, UK. a.l.moekotte@soton.ac.uk.
² Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 2YD, UK.
³ Department of Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
⁴ Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
⁵ Department of Surgery, Morriston Hospital, Swansea, UK.
⁶ Department of Surgery, Royal Free London NHS Foundation Trust, London, UK.
⁷ Department of Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁸ Department of Surgery, Royal Stoke University Hospital, Stoke, UK.
⁹ Department of Surgery, Plymouth Hospitals NHS Trust, Plymouth, UK.
¹⁰ Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
¹¹ Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹² Department of Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.

PMID: 31236723
PMCID: PMC7012970
DOI: 10.1007/s00464-019-06901-z

Abstract

Background: The laparoscopic approach in distal pancreatectomy is associated with higher rates of splenic preservation compared to open surgery. Although favorable postoperative short-term outcomes have been reported in open spleen-preserving distal pancreatectomy when compared to distal pancreatectomy with splenectomy, it is unclear whether this observation applies to the laparoscopic approach. The aim of this study is to compare laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with laparoscopic distal pancreatectomy with splenectomy (LDPS).

Study design: This is a UK wide, propensity score-matched study, including patients who underwent LSPDP or LDPS between 2006 and 2016. Short-term outcomes were compared between LSPDP and LDPS according to intention to treat. Additionally, risk factors for unplanned splenectomy were explored.

Results: A total of 456 patients were included from eleven centers (229 LSPDP and 227 LDPS). We were able to match 173 LSPDP cases to 173 LDPS cases, according to intention to treat. No differences were seen in postoperative morbidity between the groups. The only identified risk factor for unplanned splenectomy was tumor size ≥ 30 mm.

Conclusions: Preserving the spleen during laparoscopic distal pancreatectomy is not associated with a lower postoperative morbidity compared to sacrificing the spleen. Tumor size is a risk factor for unplanned splenectomy.

Keywords: Benign; Laparoscopic distal pancreatectomy; Laparoscopic spleen-preserving distal pancreatectomy; Low-grade malignant; Splenectomy.

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Conflict of interest statement

Alma L. Moekotte, Sanne Lof, Steve A. White, Ravi Marudanayagam, Bilal Al-Sarireh, Sakhanat Rahman, Zahir Soonawalla, Mark Deakin, Somaiah Aroori, Basil Ammori, Dhanny Gomez, Gabriele Marangoni, and Mohammed Abu Hilal have no conflicts of interest or financial ties to disclose.

Figures

**Fig. 1**
Study flowchart. *LDP* Laparoscopic distal pancreatectomy, *LSPDP* Laparoscopic spleen-preserving distal pancreatectomy, *PDAC* Pancreatic ductal adenocarcinoma

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Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study

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Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study

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