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Splenic Preservation Versus Splenectomy During Distal Pancreatectomy: A Systematic Review and Meta-analysis

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Studies have been published comparing spleen-preserving distal pancreatectomy (SPDP) with distal pancreatectomy with splenectomy (DPS), but the results remain inconsistent.The aim of this study was to compare SPDP with DPS by conducting a systematic review and meta-analysis.

Methods

Literature searches of the Medline/PubMed, Embase, and Cochrane Library databases were performed to identify relevant studies published before April 30, 2015. Perioperative outcomes of SPDP and DPS were evaluated. The meta-analysis was performed in random- or fixed-effects models, as appropriate. A subanalysis was conducted to compare the two techniques of splenic preservation: splenic vessel preservation (SVP) and Warshaw technique (WT).

Results

Eighteen studies and 1156 patients were included in the comparison between SPDP and DPS. A total of 502 of these patients underwent SPDP and 654 underwent DPS. Meta-analysis showed the SPDP group had significantly fewer infectious complications (odds ratio [OR] 0.57, P = 0.006), less operative blood loss (P < 0.0001), lower overall morbidity rate (OR 0.66, P = 0.002), and lower clinical pancreatic fistula rate (OR 0.42, P = 0.002) than the DPS group. Subanalysis indicated the SVP group had significantly lower rate of spleen infarction (OR 0.12, P < 0.00001) and fewer secondary splenectomies (OR 0.13, P = 0.008) than the WT group.

Conclusions

SPDP was a safe procedure associated with better short-term outcomes than DPS. SVP could provide more sufficient blood perfusion for the conserved spleen than WT. However, the evidence is limited, and more randomized controlled trials are warranted.

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Acknowledgment

Supported in part by the National Natural Science Foundation of China (Grant 81071898) and the Research Special Fund for Public Welfare Industry of Health: the Translational Research of Early Diagnosis and Comprehensive Treatment in Pancreatic Cancer (Grant 201202007).

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Ning Shi MD, Ya-Tong Li MD, Lei You PhD, Meng-Hua Dai MD & Yu-Pei Zhao MD

  2. Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China

    Shang-Long Liu MD

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Electronic supplementary material

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10434_2015_4870_MOESM1_ESM.eps

Supplementary Fig. 4. Forest plots comparing a duration of the operation, b operative blood loss, and c length of hospital stay for SPDP versus DPS (EPS 6,233 kb)

Supplementary Fig. 5. Forest plot comparing overall morbidity for SPDP versus DPS (EPS 2,668 kb)

10434_2015_4870_MOESM3_ESM.eps

Supplementary Fig. 6. Forest plots comparing a pancreatic fistula defined in any way, b pancreatic fistula defined by ISGPF (grade A, B, and C), and c clinical pancreatic fistula (ISGPF grade B and C) for SPDP versus DPS (EPS 5,376 kb)

10434_2015_4870_MOESM4_ESM.eps

Supplementary Fig. 7. Forest plots comparing a duration of the operation, b operative blood loss, and c length of hospital stay for SVP versus WT (EPS 3,480 kb)

10434_2015_4870_MOESM5_ESM.eps

Supplementary Fig. 8. Funnel plots of a infectious complications for SPDP versus DPS, and b splenic infarction for SVP versus WT (EPS 1,055 kb)

Supplementary Table 3. Gender radio, pathology, morbidity and mortality for SPDP versus DPS (DOCX 15 kb)

Supplementary Table 4. Gender radio, pathology, morbidity and mortality for SVP versus WT (DOCX 15 kb)

10434_2015_4870_MOESM8_ESM.docx

Supplementary Table 5. Results of meta-analysis of SPDP versus DPS after excluding study from Kawaguchi et al. (DOCX 17 kb)

Appendix: Statistical Analyses

Appendix: Statistical Analyses

This meta-analysis was performed in accordance with recommendations from the Cochrane Collaboration and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines10,11. Analysis was conducted using the statistical software package Review Manager Version 5.3 (Cochrane Collaboration, Software Update, Oxford, London) and Special Edition Stata Version 11.0 (StataCorp, College Station, TX). A two-tailed P value <0.05 was considered significant. Dichotomous variables were analyzed using odds ratio (OR). Analyses of the continuous variables were performed using the weighted mean difference (WMD). For studies that presented continuous data as median/mean and range values, the standard deviation (SD) was calculated using statistical algorithms12. Study quality was evaluated by the Newcastle-Ottawa Scale13. Three quality parameters were used to evaluate the quality of each study: patient selection (maximum score = 4), comparability of the study groups (maximum score = 2), and assessment of the outcome (maximum score = 3). A score of 0–9 was assigned to each study, and a score ≥6 indicated high study quality.

Here, the Cochran Q and I 2 statistics were used to show heterogeneity among studies. When the test of heterogeneity was not significant (P > 0.10) and I 2 was less than 25 %, significant heterogeneity was ruled out14,15. In this case, a fixed effects model was adopted for pooling the results16. Otherwise, a random-effects model was used17. Publication bias was assessed by funnel plots and the tests developed by Egger and Begg, with P values <0.10 indicating publication bias18,19. A trim-and-fill method was used to reduce the influence of publication bias20.

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Shi, N., Liu, SL., Li, YT. et al. Splenic Preservation Versus Splenectomy During Distal Pancreatectomy: A Systematic Review and Meta-analysis. Ann Surg Oncol 23, 365–374 (2016). https://doi.org/10.1245/s10434-015-4870-z

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