title: Clinical comparison of distal pancreatectomy with or without splenectomy: a meta-analysis.
abstract: OBJECTIVE
  A distal pancreatectomy has routinely been used for removing benign/borderline malignant tumors of the body and tail of the pancreas; however, controversy exists whether or not the spleen should be saved. Therefore, we conducted this meta-analysis for comparing the clinical outcomes of patients who underwent distal pancreatectomy with or without splenectomy.
  
  
  METHODS
  A literature research from the databases of Medline, Embase, and Cochrane library was performed to evaluate and compare the clinical outcomes between spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS). Pooled odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (95% CI) were calculated using fixed-effects or random-effects models.
  
  
  RESULTS
  Eleven non-randomized controlled studies involving 897 patients were selected to satisfy the inclusion criteria; 355 patients underwent SPDP and 542 patients underwent DPS. Compared with DPS, SPDP required a shorter hospital stay (WMD = 1.16, 95% CI = -2.00 to -0.31, P = 0.007), and had a lower incidence of intra-abdominal abscesses (OR = 0.48, 95% CI = 0.27 to 0.83, P = 0.009). In addition, spleen infarctions occurred in SPDP, most of which involved use of the Warshaw method for preserving the spleen. There were no differences between the SPDP and DPS groups with respect to operative time, operative blood loss, requirement for blood transfusion, pancreatic fistulas, thromboses, post-operative bleeding, wound infections and re-operation rates.
  
  
  CONCLUSIONS
  SPDP should be performed due to the benefits of the immune system and quick post-operative recovery. It is also essential to preserve the splenic artery and vein. Large randomized controlled trials are further needed to verify the results of this meta-analysis.
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: He
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China.
authors.forename: Daohai
authors.initials: D
authors.lastname: Qian
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Hua
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Gong
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China.
authors.forename: Shengping
authors.initials: S
authors.lastname: Lin
authors.affiliation: Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China.
authors.forename: Zhenshun
authors.initials: Z
authors.lastname: Song
mesh_terms: D018784:Abdominal Abscess / Q000473:pathology; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000503:physiopathology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010179:Pancreas / Q000473:pathology* / Q000601:surgery*; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications / Q000473:pathology; D011184:Postoperative Period; D012189:Retrospective Studies; D013154:Spleen / Q000473:pathology* / Q000601:surgery*; D013156:Splenectomy / Q000379:methods; D013157:Splenic Artery / Q000473:pathology; D016896:Treatment Outcome