09 Dec, 2019

LAPAROSCOPIC DISTAL PANCREATECTOMY WITH OR WITHOUT SPLEEN PRESERVATION: COMPARATIVE ANALYSIS OF SHORT AND LONG-TERM OUTCOMES

Sergio Renato PAIS-COSTA
Guilherme Costa Crispim de SOUSA
Sergio Luiz Melo ARAUJO
Olímpia Alves Teixeira LIMA
Sandro José MARTINS
Orlando J. TORRES
DOI: 10.1590/0102-672020190001e1461
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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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ABCD – BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY is a periodic with a single annual volume in continuous publication, official organ of the Brazilian College of Digestive Surgery - CBCD.

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