title: Minimally invasive spleen-preserving distal pancreatectomy: Does splenic vessel preservation have better postoperative outcomes? A systematic review and meta-analysis.
abstract: BACKGROUND
  Minimally invasive spleen-preserving distal pancreatectomy (SPDP) can be performed with either splenic vessel preservation (SVP) or resection [Warshaw procedure (WP)]. The aim of this study was to evaluate the postoperative clinical outcomes of patients undergoing both methods.
  
  
  METHODS
  Database search of PubMed, Embase, Scopus, Cochrane, and Google Scholar was performed (2000-2014); key bibliographies were reviewed. Qualified studies comparing patients undergoing SPDP with either SVP or WP, and assessing postoperative complications were included. Calculated pooled risk ratio (RR) with the corresponding 95% confidence interval (CI) by random effects methods were used in the meta-analyses.
  
  
  RESULTS
  The search yielded 215 studies, of which only 14 observational studies met our selection criteria. The studies included 943 patients in total; 652 (69%) underwent SVP and 291 (31%) underwent WP. Overall, there was a lower incidence of splenic infarction (RR=0.17; 95% CI: 0.09-0.33; P<0.001), gastric varices (RR=0.16; 95% CI: 0.05-0.51; P=0.002), and intra/postoperative splenectomy (RR=0.20; 95% CI: 0.08-0.49; P<0.001) in the SVP group. There was no difference in incidence of pancreatic fistula (WP vs SVP, 23.6% vs 22.9%; P=0.37), length of hospital stay, operative time or blood loss. There was moderate cross-study heterogeneity.
  
  
  CONCLUSIONS
  SVP is a safe, efficient and feasible technique that may be used to preserve the spleen. WP may be more suitable for large tumors close to the splenic hilum or those associated with splenomegaly. Randomized clinical trials are justified to examine the long-term benefits of SVP-SPDP.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Miami, Florida, USA. dyakoub@med.miami.edu.
authors.forename: Fady
authors.initials: F
authors.lastname: Elabbasy
authors.forename: Rahul
authors.initials: R
authors.lastname: Gadde
authors.forename: Mena M
authors.initials: MM
authors.lastname: Hanna
authors.forename: Danny
authors.initials: D
authors.lastname: Sleeman
authors.forename: Alan
authors.initials: A
authors.lastname: Livingstone
authors.forename: Danny
authors.initials: D
authors.lastname: Yakoub
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016017:Odds Ratio; D009926:Organ Preservation / Q000009:adverse effects / Q000379:methods*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D013154:Spleen / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D013156:Splenectomy; D013157:Splenic Artery / Q000601:surgery*; D013162:Splenic Vein / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult