The value of splenic preservation with distal pancreatectomy.
OBJECTIVE
Splenic-preserving distal pancreatectomy for benign or low-grade malignant disease is associated with decreased perioperative morbidity compared with conventional distal pancreatectomy with splenectomy.


METHODS
A retrospective review of a prospective database of patients.


METHODS
Memorial Sloan-Kettering Cancer Center, New York, NY.


METHODS
All patients (N = 211) undergoing distal pancreatectomy.


METHODS
Perioperative complications, length of postoperative stay, and overall survival times were analyzed.


RESULTS
After excluding patients with adenocarcinoma and those who had other major organ resection, 125 patients underwent distal pancreatectomy for benign or low-grade malignant disease with splenectomy (n = 79) or splenic preservation (n = 46). Perioperative complications occurred in 39 (49%) of the 79 patients following splenectomy and 18 (39%) of the 46 patients following splenic preservation (P =.21). Perioperative infectious complications and severe complications were significantly higher in the splenectomy group (28% and 11%) compared with the splenic preservation group (9% and 2%) (P =.01 and.05), respectively. Length of hospital stay was 9 days (range, 5-41 days) following splenectomy and 7 days (range, 5-26 days) following splenic preservation (P<.01). No difference in length of surgery, units of blood transfused, or perioperative mortality was noted between groups.


CONCLUSIONS
Splenic preservation following distal pancreatectomy for benign or low-grade malignant disease is safe and is associated with a reduction in perioperative infectious complications, severe complications, and length of hospital stay compared with conventional distal pancreatectomy with splenectomy. Therefore, splenic preservation should be considered in this group of patients.
Shoup
Margo
M
Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, NY, NY 10021, USA.
Brennan
Murray F
MF
McWhite
Kertrisa
K
Leung
Denis H Y
DH
Klimstra
David
D
Conlon
Kevin C
KC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010182:Pancreatic Diseases / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013154:Spleen / Q000098:blood supply*; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome