Laparoscopic Distal Pancreatectomy With Spleen Preservation

Pais-Costa, Sérgio Renato; Sousa, Guilherme Costa Crispim de; Araujo, Sergio Luiz Melo; Lima, Olímpia Alves Teixeira

doi:10.1590/0102-672020180001e1395

Cited by 4 publications

(10 citation statements)

References 22 publications

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“…The safety and effectiveness of laparoscopic distal pancreatectomy for treating pancreatic neoplasia has now been proven. This procedure is an excellent choice, compared with open surgery, regarding oncological radicality and long-term results 28 Additionally to the clear advantages relating to lower morbidity caused by incisions, this access route presents less pain during the postoperative period, shorter hospitalization and earlier recovery to resume work and daily activities 5 , 6 , 10 , 17 , 24 , 30 .…”

Section: Discussionmentioning

confidence: 99%

“…In addition, splenectomy has also been correlated with thrombocytosis and thrombosis of the splenic and portal veins. Therefore, preservation of the spleen also reduces the chance of occurrences of these specific complications that relate to the act of the splenectomy itself 17 , 24 , 29 .…”

Section: Discussionmentioning

confidence: 99%

“…In general, whenever possible, our team chooses not to undertake spleen preservation through Warshaw’s technique. Although this technique is considered to be simpler and faster, in addition to requiring less expertise and involving less intra-operative bleeding, it has been associated with larger numbers of specific post-operative complications relating to splenic vessel ligature, such as splenic infarction and gastric fundus varices due to left portal hypertension 17 , 28 , 29 .…”

Section: Discussionmentioning

confidence: 99%

“…Although in a previous study 17 we showed that laparoscopic distal pancreatectomy with spleen preservation using preservation of the splenic vessels technique (LDPSPPSV) yielded good results, uncertainties relating to the different indications for LDPS and LDPSP remain, regarding the real practical benefit of splenic tissue preservation over the short or long term and other possible advantages not previously studied. Therefore, a comparative study between the LDPS and LDPSPPSV techniques was proposed.…”

Section: Introductionmentioning

confidence: 89%

“…The surgical technique used in the present study was standardized by the team in all procedures and was described in a previous publication 17 . Essentially, four or five portals were used with 30 0 optics in a central position (Figures 1A and 1B).The final aspect of the surgeries can be observed in Figures 2A and 2B).…”

Section: Methodsmentioning

confidence: 99%

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Laparoscopic Distal Pancreatectomy With or Without Spleen Preservation: Comparative Analysis of Short and Long-Term Outcomes

Pais-Costa

Sousa

Araujo

et al. 2019

ABCD, arq. bras. cir. dig.

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Background: Laparoscopic distal pancreatectomy (LDP) is the preferred approach for resection of tumors in the distal pancreas because of its many advantages over the open approach. Aim: To analyse and compare short and long-term outcomes from LDP performed through two different techniques: with splenectomy vs. spleen preservation and splenic vessel preservation. Method: Fifty-eight patients were operated and subsequently divided between two groups: Group 1, LDP with splenectomy (LDPS); and Group 2, LDP with spleen preservation and preservation of splenic vessels (LDPSPPSV). Results:The epidemiological characteristics were statistically similar between the two groups (age, gender, BMI and lesion size). Both the mean of operative time (p=0.04) and the mean of intra-operative blood loss (p=0,03) were higher in Group 1. The mean of resected lymph nodes was also higher in Group 1 (p<0.000). There were no statistic differences between the groups in relation to open conversion, morbidity or early postoperative mortality. The mean hospital stay was similar between groups. Pancreatic fistula (grade B and C) was similar between the groups. The mean of overall follow-up was 37.6 months (5-96). Late complications were similar between the groups. Conclusion: Both techniques were superimposable; however, LDPS presented, respectively, higher intra-operative bleeding, longer duration of the operation and higher number of lymph nodes resected. No differences were observed in the studied period in relation to the appearance of infections or neoplasm related to splenectomy during follow-up. Maintenance of the spleen avoided periodic immunizations in patients in LDPSPSV. It is indicated in small pancreatic lesions with indolent course.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 89%

Section: Methodsmentioning

confidence: 99%

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Laparoscopic Distal Pancreatectomy With or Without Spleen Preservation: Comparative Analysis of Short and Long-Term Outcomes

Pais-Costa

Sousa

Araujo

et al. 2019

ABCD, arq. bras. cir. dig.

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Magnetic Resonance Cholangiopancreatography (Mrcp) Versus Endosonography-Guided Fine Needle Aspiration (Eus-Fna) for Diagnosis and Follow-Up of Pancreatic Intraductal Papillary Mucinous Neoplasms

Costa

Guerra

Goldman

et al. 2019

ABCD, arq. bras. cir. dig.

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Background:Intraductal papillary mucinous tumor (IPMN) are being diagnosed with increasing frequency. Computerized tomography scanning is commonly used as the primary imaging modality before surgery nonetheless magnetic resonance cholangiopancreatography (MRCP) provides better characterization. Endosonography-guided fine needle aspiration (EUS-FNA) has emerged as a way to reach pathological diagnose. Aim:To compare results of both methods with surgical pathology findings for classification of IPMN. Methods:Thirty-six patients submitted to surgical resection with preoperative suspect of IPMN were submitted preoperatively to MRCP and EUS-FNA. Images obtained were analyzed according to a classification determined for each method. ROC curve was used for statistical analysis, that compared the images tests with the purpose of finding the best method for diagnosis and classification of IPMN. Results:Sixteen patients underwent pancreatoduodenectomy, 16 to subtotal pancreatectomy and only four laparotomy. Pathological diagnosis was IPMN (n=33) and pancreatic intraepithelial neoplasia type 2 (n=3). Twenty-nine revealed non-invasive neoplasia and invasive form in four patients. MRCP and EUS-FNA have correctly diagnosed and classified (type of IPMN), in 62.5% and 83.3% (p=0.811), the affected segment location in 69% and 92% (p=0.638) and identification of nodules and/or vegetation presence in 45% and 90% (p=0.5). Regarding to histopathological diagnosis by EUS-FNA the sensitivity was 83.3%; specificity was 100%; positive predictive value was 100%; negative predictive value was 33.3% and accuracy was 91.7%. Conclusions:There was no significant difference in the diagnosis of IPMN. However, EUS-FNA showed better absolute results than MRCP to identify nodule and/or vegetation.

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Robot-assisted distal pancreatectomy improves spleen preservation rate versus laparoscopic distal pancreatectomy for benign and low-grade malignant lesions of the pancreas

Jiang¹,

Zheng²,

Zhang³

et al. 2020

Transl Cancer Res TCR

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Background: The aim of this retrospective study was to compare robot-assisted distal pancreatectomy (RDP) with laparoscopic distal pancreatectomy (LDP) for patients with benign and low-grade malignant lesions of the pancreas.Methods: This study included 166 patients who underwent RDP (n=63) or LDP (n=103) for benign or low-grade malignant lesions of the pancreas from January 2011 to October 2018 in Changhai Hospital. A retrospective analysis was performed between the two groups. The primary points were operation time, operative blood loss, hospital stay, pancreatic fistula and spleen preservation.Results: There were no significant differences in patient characteristics or indications between RDP and LDP. Notably, among all patients, RDP was associated with a significantly higher rate of spleen preservation than that for LDP (30.2% vs. 6.8%, P<0.001), while other intraoperative variables were similar between the two groups. No death cases in the study group within 30 days were reported in either group. Referring to postoperative outcomes, postoperative pancreatic fistula (POPF) was 22% for the RDP group and 33% for the LDP group. In addition, the rate of clinically significant grade B/C pancreatic fistula was 5% and 7%, respectively. There were also no significant differences in hospital stay (6.0±3.0 vs. 6.4±2.5, P=0.404).Furthermore, the univariate analysis demonstrated that tumor size (P=0.001) and surgery group (RDP/LDP) (P=0.002) were associated with SP rate independent factor for spleen preservation.Conclusions: RDP is an effective and safe technique with significant advantage in spleen preservation for patients with benign and low-grade malignant lesions in the distal pancreas.

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Laparoscopic Distal Pancreatectomy With Spleen Preservation

Cited by 4 publications

References 22 publications

Laparoscopic Distal Pancreatectomy With or Without Spleen Preservation: Comparative Analysis of Short and Long-Term Outcomes

Laparoscopic Distal Pancreatectomy With or Without Spleen Preservation: Comparative Analysis of Short and Long-Term Outcomes

Magnetic Resonance Cholangiopancreatography (Mrcp) Versus Endosonography-Guided Fine Needle Aspiration (Eus-Fna) for Diagnosis and Follow-Up of Pancreatic Intraductal Papillary Mucinous Neoplasms

Robot-assisted distal pancreatectomy improves spleen preservation rate versus laparoscopic distal pancreatectomy for benign and low-grade malignant lesions of the pancreas

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