Minimally invasive spleen-preserving distal pancreatectomy: Does splenic vessel preservation have better postoperative outcomes? A systematic review and meta-analysis
| Autor: | Alan S. Livingstone, Fady Elabbasy, Mena M. Hanna, Danny Yakoub, Rahul Gadde, Danny Sleeman |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent medicine.medical_treatment Splenic artery Risk Assessment Young Adult Pancreatectomy Postoperative Complications Risk Factors medicine.artery Odds Ratio Medicine Humans Minimally Invasive Surgical Procedures Aged Aged 80 and over Hepatology business.industry Patient Selection Gastroenterology Odds ratio Organ Preservation Gastric varices Middle Aged medicine.disease Surgery Pancreatic Neoplasms Splenic Hilum Treatment Outcome Splenic vein Splenic Vein Meta-analysis Splenic infarction Splenectomy Female business Splenic Artery Spleen |
| Zdroj: | Hepatobiliarypancreatic diseases international : HBPD INT. 14(4) |
| ISSN: | 1499-3872 |
| Popis: | Minimally invasive spleen-preserving distal pancreatectomy (SPDP) can be performed with either splenic vessel preservation (SVP) or resection [Warshaw procedure (WP)]. The aim of this study was to evaluate the postoperative clinical outcomes of patients undergoing both methods.Database search of PubMed, Embase, Scopus, Cochrane, and Google Scholar was performed (2000-2014); key bibliographies were reviewed. Qualified studies comparing patients undergoing SPDP with either SVP or WP, and assessing postoperative complications were included. Calculated pooled risk ratio (RR) with the corresponding 95% confidence interval (CI) by random effects methods were used in the meta-analyses.The search yielded 215 studies, of which only 14 observational studies met our selection criteria. The studies included 943 patients in total; 652 (69%) underwent SVP and 291 (31%) underwent WP. Overall, there was a lower incidence of splenic infarction (RR=0.17; 95% CI: 0.09-0.33; P0.001), gastric varices (RR=0.16; 95% CI: 0.05-0.51; P=0.002), and intra/postoperative splenectomy (RR=0.20; 95% CI: 0.08-0.49; P0.001) in the SVP group. There was no difference in incidence of pancreatic fistula (WP vs SVP, 23.6% vs 22.9%; P=0.37), length of hospital stay, operative time or blood loss. There was moderate cross-study heterogeneity.SVP is a safe, efficient and feasible technique that may be used to preserve the spleen. WP may be more suitable for large tumors close to the splenic hilum or those associated with splenomegaly. Randomized clinical trials are justified to examine the long-term benefits of SVP-SPDP. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect