title: Laparoscopic spleen-preserving distal pancreatectomy in elderly subjects: splenic vessel sacrifice may be associated with a higher rate of splenic infarction.
abstract: BACKGROUND
  Laparoscopic spleen-preserving distal pancreatectomy has gained popularity in recent years. Splenic preservation can be achieved with or without splenic vessel preservation (SVP). The potential morbidity of this approach in patients aged >70 years has not been well defined.
  
  
  METHODS
  Ten patients aged >70 years underwent attempted laparoscopic spleen-preserving distal pancreatectomy within a 2-year period. Multiple patient parameters were examined and chi-squared analysis was used to evaluate the association between the operative technique (SVP or splenic vessel division [SVD]) and splenic infarction. The Mann-Whitney test was used to compare the SVP and SVD groups with regard to age, estimated blood loss (EBL), operating time, splenic volume and length of stay (LoS).
  
  
  RESULTS
  Median age was 81 years (range: 71-92 years). Operating room time, LoS, EBL and complication rates were similar to those reported in published series of younger patients. In four patients, the splenic vessels were divided in a manner relying on short gastric collateral flow; SVP was achieved in all other patients. All four patients who underwent SVD developed splenic infarcts and three required splenectomy to manage this (P=0.002). Median LoS was increased in the SVD group (9.3 days vs. 4.3 days; P=0.053). Estimated blood loss was higher in the SVP group (200 ml vs. 100 ml; P=0.091). One pancreatic leak occurred. There were no mortalities.
  
  
  CONCLUSIONS
  Spleen-preserving laparoscopic distal pancreatectomy can be performed safely in elderly patients, with results comparable with those achieved in younger subjects. However, elderly patients undergoing division of the splenic artery and vein may be at higher risk for splenic infarct and the aetiology of this is unclear.
authors.affiliation: Division of Surgical Oncology, Roger Williams Medical Center, Providence, RI 02908, USA.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Baldwin
authors.forename: Steven C
authors.initials: SC
authors.lastname: Katz
authors.forename: N Joseph
authors.initials: NJ
authors.lastname: Espat
authors.forename: Ponnandai
authors.initials: P
authors.lastname: Somasundar
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D012086:Reoperation; D012237:Rhode Island; D018570:Risk Assessment; D012307:Risk Factors; D013154:Spleen / Q000098:blood supply*; D013156:Splenectomy; D013157:Splenic Artery / Q000601:surgery; D013159:Splenic Infarction / Q000209:etiology* / Q000601:surgery; D013162:Splenic Vein / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome