Spleen preserving distal pancreatectomy (SPDP) represents a widely adopted procedure in the presence of benign or low-grade malignant tumors. Splenic vessels preservation and resection (Kimura and Warshaw techniques respectively) represent the two main surgical modalities to avoid splenic resection. Each one is characterized by strengths and drawbacks. The aim of the present study is to systematically review the current high-quality evidence regarding these two techniques and analyze their short-term outcomes.
A systematic review was conducted according to PRISMA, AMSTAR II and MOOSE guidelines. The primary endpoint was to assess the incidence of splenic infarction and splenic infarction leading to splenectomy. As secondary endpoints, specific intraoperative variables and postoperative complications were explored. Metaregression analysis was conducted to evaluate the effect of general variables on specific outcomes.
Seventeen high-quality studies were included in quantitative analysis. A significantly lower risk of splenic infarction for patients undergoing Kimura SPDP (OR = 0.14; p < 0.0001). Similarly, splenic vessel preservation was associated with a reduced risk of gastric varices (OR = 0.1; 95% p < 0.0001). Regarding all secondary outcome variables, no differences between the two techniques were noticed. Metaregression analysis failed to identify independent predictors of splenic infarction, blood loss, and operative time among general variables.
Although Kimura and Warshaw SPDP have been demonstrated comparable for most of postoperative outcomes, the former resulted superior compared to the latter in reducing the risk of splenic infarction and gastric varices. For benign pancreatic tumors and low-grade malignancies Kimura SPDP may be preferred.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to HPB
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the international study group on pancreatic surgery (isgps).Surgery. 2014; : 156https://doi.org/10.1016/j.surg.2014.06.016
- Preferred reporting Items for systematic reviews and meta-analyses: the PRISMA statement.PLoS Med. 2009; 6e1000097https://doi.org/10.1371/journal.pmed.1000097
- AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both.BMJ. 2017; 358: j4008https://doi.org/10.1136/bmj.j4008
- Assessing risk of bias in a non-randomized study.Cochrane Handb Syst Rev Interv. 2019; 2: 621-641https://doi.org/10.1002/9781119536604.ch25
- Chapter 8: assessing risk of bias in a randomized trial.in: Higgins J.P.T. Thomas J. Chandler J. Cumpston M. Li T. Page M.J.W.V. Cochrane handbook for systematic reviews of interventions version 6.1 (updated september 2020). 2020
- Levels of evidence and grades of recommendation.Oxford Cent Evid Based Med 1998. 2009;
- The newcastle-ottawa scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. 2012https://doi.org/10.2307/632432 ((Available from: URL http//www.ohri.ca/programs/clinical_epidemiology/oxford.asp)
- Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.BMC Med Res Methodol. 2014; 14https://doi.org/10.1186/1471-2288-14-135
- Measuring inconsistency in meta-analyses.Br Med J. 2003; 327: 557-560https://doi.org/10.1136/bmj.327.7414.557
- R: a language and environment for statistical computing. Vienna, Austria. 2019 (https://doi.org/http://www.R-project.org/)
- An introduction to meta-analysis in R. 2015https://doi.org/10.1007/978-3-319-21416-0_1
- Conducting meta-analyses in R with the metafor.J Stat Software. 2010; 36 (https://doi.org/https://www.jstatsoft.org/v36/i03)
- Meta-analysis of the difference of medians.Biom J. 2020; 62: 69-98https://doi.org/10.1002/bimj.201900036
- Doing meta-analysis in R: a hands-on guide.Prot Lab. 2019; https://doi.org/10.5281/zenodo.2551803
- Splenic preserving distal pancreatectomy: does vessel preservation matter?.J Am Coll Surg. 2011; 212https://doi.org/10.1016/j.jamcollsurg.2010.12.014
- Laparoscopic spleen-preserving distal pancreatectomy in elderly subjects: splenic vessel sacrifice may Be associated with a higher rate of splenic infarction.HPB. 2011; 13https://doi.org/10.1111/j.1477-2574.2011.00341.x
- Study on laparoscopic spleen preserving distal pancreatectomy procedures comparing splenic vessel preservation and non-preservation.Transl Gastroenterol Hepatol. 2016; 1: 27https://doi.org/10.21037/tgh.2016.03.24
- Splenic preservation in laparoscopic distal pancreatectomy.Br J Surg. 2017; 104https://doi.org/10.1002/bjs.10434
- Long term outcome after minimally invasive and open Warshaw and Kimura techniques for spleen-preserving distal pancreatectomy: international multicenter retrospective study.Eur J Surg Oncol. 2019; 45https://doi.org/10.1016/j.ejso.2019.04.004
- Effect of vessel preservation on splenic volume and function in patients with spleen preserving distal pancreatectomies.HPB. 2020; 22https://doi.org/10.1016/j.hpb.2020.01.012
- Short-term outcomes after spleen-preserving minimally invasive distal pancreatectomy with or without preservation of splenic vessels.Ann Surg Publish Ah. 2021; 277: e119-e125https://doi.org/10.1097/sla.0000000000004963
- Robotic spleen-preserving distal pancreatectomy: the verona experience.Updates Surg. 2021; 73https://doi.org/10.1007/s13304-020-00731-8
- Kimura-first” Strategy for robotic spleen-preserving distal pancreatectomy: Experiences from 61 consecutive Cases in a single institution.Gland Surg. 2021; 10https://doi.org/10.21037/gs-20-576
- Perioperative and long-term results of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessels conservation: a retrospective analysis.J Surg Oncol. 2012; 105https://doi.org/10.1002/jso.22117
- Robot-assisted spleen-preserving distal pancreatectomy: a single surgeon's experiences and proposal of clinical application.Surg Endosc. 2013; 27https://doi.org/10.1007/s00464-012-2551-6
- Laparoscopic spleen-preserving distal pancreatectomy: splenic vessel preservation compared with the Warshaw technique.JAMA Surg. 2013; 148https://doi.org/10.1001/jamasurg.2013.768
- Laparoscopic spleen-preserving distal pancreatectomy with and without splenic vessel preservation: the role of the Warshaw procedure.Pancreatology. 2014; 14https://doi.org/10.1016/j.pan.2014.09.007
- Laparoscopic spleen-preserving distal pancreatectomy: the technique must suit the lesion.J Gastrointest Surg. 2014; 18https://doi.org/10.1007/s11605-014-2561-x
- Laparoscopic spleen-preserving distal pancreatectomy: comparative study of spleen preservation with splenic vessel resection and splenic vessel preservation.World J Surg. 2014; 38https://doi.org/10.1007/s00268-014-2671-3
- Distal pancreatectomy with splenic preservation: a short-term outcome analysis of the Warshaw technique.Int J Surg. 2015; 21https://doi.org/10.1016/j.ijsu.2015.06.051
- Minimally invasive approach for spleen-preserving distal pancreatectomy: a comparative analysis of postoperative complication between splenic vessel conserving and Warshaw's technique.J Gastrointest Surg. 2016; 20https://doi.org/10.1007/s11605-016-3141-z
- Risk of cancer following splenectomy.Int J Cancer. 1996; 66https://doi.org/10.1002/(SICI)1097-0215(19960529)66:5<611::AID-IJC5>3.0.CO;2-W
- The impact of splenectomy on outcomes after resection of pancreatic adenocarcinoma.J Am Coll Surg. 1999; 188https://doi.org/10.1016/S1072-7515(99)00041-1
- The value of splenic preservation with distal pancreatectomy.Arch Surg. 2002; 137https://doi.org/10.1001/archsurg.137.2.164
Published online: February 28, 2023
Accepted: February 10, 2023
Received: July 24, 2022
Publication stageIn Press Corrected Proof
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.