Spleen-preserving pancreatectomy with removal of splenic vessels: impact on splenic parenchyma ?

BMC Surgery

Research

Mike Salavracos¹  Maria Luisa Rosa²  Martina Pezzullo²  Benoit Navez³  Martin Brichard³  Catherine Hubert³  Jean Closset⁴  Coralie Lete⁴  Julie Navez⁴ 

[1] Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, 1200, Brussels, Belgium;Surgiprint 3D Intelligence, 1348, Louvain-La-Neuve, Belgium;Department of Radiology, Hôpital Erasme, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium;Hepato-Biliary and Pancreatic Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, 1200, Brussels, Belgium;Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology Hôpital Erasme, Hôpital Universitaire de Bruxelles (HUB), Route de Lennik 808, 1070, Brussels, Belgium;

关键词: Distal pancreatectomy;    Spleen preservation;    Splenic vessels;    Splenic ischemia;    Splenic volume;   

DOI  :  10.1186/s12893-023-02133-0

 received in 2023-04-16, accepted in 2023-07-31,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundWhile outcomes after spleen-preserving distal pancreatectomy (SP-DP) have been widely reported, impacts on splenic parenchyma have not been well studied. This study aimed to compare postoperative outcomes, particularly spleen-related outcomes, by assessing splenic imaging after SP-DP with or without splenic vessels removal.MethodsData for all patients who underwent SP-DP with splenic vessels removal (Warshaw technique, WDP) or preservation (Kimura technique, KDP) between 2010 and 2022 in two tertiary centres were retrospectively analysed. Splenic ischemia and volume at early/late imaging and postoperative outcomes were reviewed.ResultsEighty-seven patients were included, 51 in the WDP and 36 in the KDP groups. Median Charlson’s Comorbidity Index was significantly higher in the WDP group compared with the KDP group. Postoperative morbidity was similar between groups. There was more splenic ischemia at early imaging in the WDP group compared to the KDP group (55% vs. 14%, p = 0.018), especially severe ischemia (23% vs. 0%). Partial splenic atrophy was observed in 29% and 0% in the WDP and KDP groups, respectively (p = 0.002); no complete splenic atrophy was observed. Platelet levels at POD 1, 2 and 6 were significantly higher in the WDP group compared to KDP group. At univariate analysis, age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction were prognostic factors for development of splenic atrophy. No episodes of overwhelming post-splenectomy infection or secondary splenectomy were recorded after a median follow-up of 9 and 11 months in the WDP and KDP groups, respectively.ConclusionsSplenic ischemia appeared in one-half of patients undergoing SP-DP with splenic vessels removal at early imaging, and partial splenic atrophy in almost 30% at late imaging, without clinical impact or complete splenic atrophy. Age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction could help to predict the occurrence of splenic atrophy.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 1