Distal pancreatectomy with splenic preservation: A short-term outcome analysis of the Warshaw technique

Boselli, Carlo; Barberini, Francesco; Listorti, Chiara; Castellani, Elisa; Renzi, Claudio; Corsi, Alessia; Grassi, Veronica; Cacurri, Alban; Desiderio, Jacopo; Trastulli, Stefano; Santoro, Alberto; Pironi, Daniele; Burattini, Federica; Cirocchi, Roberto; Avenia, Nicola; Noya, Giuseppe; Parisi, Amilcare

doi:10.1016/j.ijsu.2015.06.051

Cited by 14 publications

(8 citation statements)

References 23 publications

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“…Those challenging SPDP suggest that it is a more tedious procedure with a greater chance of adjacent vascular/organ injury [38][39][40][41]. This was not shown in our analysis.…”

Section: Discussionmentioning

confidence: 63%

Distal pancreatectomy for benign and low grade malignant tumors: Short‐term postoperative outcomes of spleen preservation—A systematic review and update meta‐analysis

Pendola

Gadde

Ripat

et al. 2017

Journal of Surgical Oncology

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“…Those challenging SPDP suggest that it is a more tedious procedure with a greater chance of adjacent vascular/organ injury [38][39][40][41]. This was not shown in our analysis.…”

Section: Discussionmentioning

confidence: 63%

Distal pancreatectomy for benign and low grade malignant tumors: Short‐term postoperative outcomes of spleen preservation—A systematic review and update meta‐analysis

Pendola

Gadde

Ripat

et al. 2017

Journal of Surgical Oncology

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“…The risk of developing gastric or esophageal varices with potential varices bleeding due to a portal hypertension caused by the Warshaw procedure is a concern regarding this technique in the pancreatic community [2,[9][10][11] . Although this was not the focus of this study, it is of note, that none of the 18 patients in the C-LDP group and none of the 5 patients in the RA-LDP group who underwent a Warshaw procedure and were followed up showed signs of gastric or esophageal varices on postoperative imaging; also none developed varices bleeding after a median follow-up of 6 (RA-LDP) and 30.5 (C-LDP) months, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Spleen-preservation during distal pancreatectomy (DP) offers benefits like lower morbidity and shorter hospitalization time [7][8][9] . Moreover, the risk of developing gastric or esophageal varices and potential varices bleeding due to a portal hypertension is reduced by preserving the splenic vein [2,[9][10][11] . Since several authors reported serious problems like splenic infarctions or abscesses after the Warshaw procedure [12,13] , it is supposed that vessel-preserving spleen-preservation (SP) in DP is beneficial for patients with benign and borderline tumors [11,14,15] .…”

Section: Introductionmentioning

confidence: 99%

Robotic-Assisted Approach Improves Vessel Preservation in Spleen-Preserving Distal Pancreatectomy

et al. 2016

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Background: Vessel-preserving spleen preservation (SP) during distal pancreatectomy (DP) is supposed to be beneficial for patients with benign and borderline tumors. This study evaluated the first experiences with robotic-assisted laparoscopic DP (RA-LDP) and its rate of vessel preservation and SP compared to conventional laparoscopic DP (C-LDP). Methods: Patients scheduled for spleen-preserving DP for benign or borderline tumors by either C-LDP or RA-LDP were retrieved from a prospective database and retrospectively analyzed regarding vessel-preservation and SP, conversion rate, blood loss, operating time, complications, perioperative blood transfusion, postoperative hospital stay (PHS) and mortality. Results: Twenty-nine patients underwent C-LDP and 12 patients underwent RA-LDP between September 2009 and May 2015. SP rates were 79% (23 of 29) in the C-LDP and 92% (11 of 12) in the RA-LDP group (p = 0.32). Splenic vessels could be preserved in 17% (5 of 29) of the C-LDP and 50% (6 of 12) of the RA-LDP group (p = 0.052). Operating time, intraoperative blood loss, the number of perioperative red blood cell transfusions, overall morbidity and the rate of postoperative pancreatic fistulas were not different between the groups. PHS was shorter in the RA-LDP group (10.5 vs. 13 days; p = 0.02). Conclusion: RA-LDP for benign or borderline tumors of the pancreas is a safe procedure and tended to be associated with a better vessel-preservation rate, thereby making it a good alternative to C-LDP.

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“…Distal pancreatectomy (DP) is traditionally combined with splenectomy. Splenic preservation DP (SPDP) has gained popularity for resection of benign or low-grade malignant lesions of the distal pancreas due to the bene t of avoiding short-term (Overwhelming post-splenectomy infection, OPSI) and long-term postsplenectomy complications (hypercoagulabitlity, increased risk of malignant tumors) 4,5 . Typical indications for SPDP include: mucinous cystic neoplasm (MCN), low-grade pancreatic neuroendocrine tumor (pNET), benign intraductal papillary mucinous neoplasm (IPMN), and solid pseudopapillary neoplasm (SPN).…”

Section: Introduction Background and Rationale {6a}mentioning

confidence: 99%

“…Kimura approach and Warshaw technique are two commonly reported approaches to SPDP 6 . Though technically challenging, Kimura procedure is the most ideal choice because it preserves the native vasculature of the spleen and could avoid complications such as splenic infarction, abscess or perigastric collateral/ submucosal varices (66% varices rate reported by Boselli et al) after Warshaw technique 5,7 .…”

Section: Introduction Background and Rationale {6a}mentioning

confidence: 99%

Efficacy of robotic versus laparoscopic approach in spleen preserving distal pancreatectomy for benign or low-grade malignant pancreatic tumors: study protocol for a randomized controlled trial

Tian¹,

Lu²,

Liu³

et al. 2020

Preprint

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BackgroundBased on previous meta-analyses and comparative evidence, robotic approach might lead to a higher or at least similar spleen-preservation rates when comparing with laparoscopic approach in spleen preserving distal pancreatectomy (SPDP) for benign or low-grade malignant pancreatic tumors1–3. But high-quality evidence lacks and controversy exists. Therefore, we planned to initiate a prospective, patient-blinded, randomized, controlled trial (RCT) to compare robotic assisted spleen preserving distal pancreatectomy (RSPDP) with laparoscopic spleen preserving distal pancreatectomy (LSPDP), with special consideration to the success rate of splenic vessel-preserving (Kimura) approach, as well as perioperative variables, and cost analysis.MethodsPatients with benign or low-grade malignant pancreatic tumors are potential candidates for this RCT. Enrolled participants are randomized into RSPDP (observational arm) or LSPDP (control arm) groups as a ratio of 1:1. The primary outcome is the success rate of splenic vessel-preserving (Kimura) approach. The secondary outcomes include total success rate of spleen preserving (Kimura and Warshaw approaches), intraoperative variables, time to functional recovery, postoperative complications, mortality, and cost/efficacy analysis.DiscussionWe plan to conduct a randomized controlled trial to detect the potential advantages of robotic approach in spleen vessels preservation compared with traditional laparoscopic approach. RSPDP may improve spleen vessels preservation rate in selected patients.Trial registrationChinese Clinical Trial Registry, No: ChiCTR2000029177. Registered on 18 January, 2020.

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Distal pancreatectomy with splenic preservation: A short-term outcome analysis of the Warshaw technique

Abstract: WT is safe and feasible, even if there are not definitive evidences that demonstrate it is superior to classic SVP. RCTs are needed to determine advantages and disadvantages of WT compared to the classic SVP.

Cited by 14 publications

References 23 publications

Distal pancreatectomy for benign and low grade malignant tumors: Short‐term postoperative outcomes of spleen preservation—A systematic review and update meta‐analysis

Distal pancreatectomy for benign and low grade malignant tumors: Short‐term postoperative outcomes of spleen preservation—A systematic review and update meta‐analysis

Robotic-Assisted Approach Improves Vessel Preservation in Spleen-Preserving Distal Pancreatectomy

Efficacy of robotic versus laparoscopic approach in spleen preserving distal pancreatectomy for benign or low-grade malignant pancreatic tumors: study protocol for a randomized controlled trial

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