Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
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Article info
Publication history
Published online: February 28, 2023
Accepted:
February 10,
2023
Received:
July 24,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
