Spleen-preserving distal pancreatectomy or distal pancreatectomy with splenectomy?: Perioperative and patient-reported outcome analysis.
OBJECTIVE
We designed this study to evaluate the efficacy of spleen salvage during distal pancreatectomy for patients with benign and borderline malignant tumors.


BACKGROUND
Despite the emphasis on its role, the spleen has commonly been removed in distal pancreatectomy.


METHODS
From January 2005 to July 2009, 82 patients underwent distal pancreatectomy with splenectomy (DPS) and 78 patients underwent spleen-preserving distal pancreatectomy (SPDP). Medical records were retrospectively reviewed.


RESULTS
There were no significant differences in demographics, final diagnoses, estimated blood loss, intraoperative transfusion, and operative time between the 2 groups. More perioperative complications occurred in the DPS group than in the SPDP group (P=0.0344). Consequently, postoperative hospital stay was significantly shorter in the SPDP group than in the DPS group (P=0.0273). In the follow-up survey, episodes of common cold or flu were apparently more frequent in the DPS group (P=0.047). More patients in the DPS group felt fatigue (P=0.0481) and poor health condition (P=0.0371). Less newly developed (P=0.0193) and aggravated diabetes mellitus (P=0.0361) were also observed in the SPDP group. Platelet counts on postoperative day (POD) 5, hemoglobin on POD 3, WBC counts, and CRP level on POD 2 were significantly higher in the DPS group than in the SPDP group and these differences continued to be significant for months after surgery.


CONCLUSIONS
In addition to frequent higher grade complications, prolonged hospital stays, and severe hematological abnormalities, DPS seemed to result in poor health condition based on the follow-up survey. Even an effort to preserve an adult spleen in distal pancreatectomy is worthwhile.
Department of Hepatobiliary Surgery, First People's Hospital affiliated to Huzhou University Medical College, Huzhou, Zhejiang Province, China.
Cheng Wu
CW
Tang
Wen Ming
WM
Feng
Ying
Y
Bao
Mao Yun
MY
Fei
Yu Long
YL
Tao
D000368:Aged; D002097:C-Reactive Protein; D003139:Common Cold / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007251:Influenza, Human / Q000209:etiology; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D010976:Platelet Count; D012189:Retrospective Studies; D057566:Self Report; D013156:Splenectomy / Q000009:adverse effects
D006454:Hemoglobins; D002097:C-Reactive Protein