title: An Analysis of Complications, Quality of Life, and Nutritional Index After Laparoscopic Distal Pancreatectomy with Regard to Spleen Preservation.
abstract: BACKGROUND
  Whether splenectomy is adverse or spleen preservation offers significant advantages in distal pancreatic resection is unclear. The aim was to compare the early/late clinical results and the functional outcomes in terms of quality of life (QoL) and nutrition between conventional laparoscopic distal pancreatectomy (LDP) and laparoscopic spleen-preserving distal pancreatectomy (LSPDP).
  
  
  METHODS
  Clinical data and computed tomography findings of 111 laparoscopic distal resections (79 LDPs and 32 LSPDPs) between 1999 and 2012 were retrospectively reviewed. QoL was assessed by the EORTC QLQ-C30. Body mass index and biochemical tests were examined as nutritional indices. Comparative analysis was done.
  
  
  RESULTS
  The mean follow-up was 25 months. The operation time was shorter in LSPDP (127.9 minutes vs. 158.0 minutes, P < .001). The lesion size was larger in LDP (36.8 mm vs. 27.2 mm, P < .01). Mucinous cystic neoplasm (MCN) was the most common diagnosis in LDP and intraductal papillary mucinous neoplasm (IPMN) in LSPDP. Early results showed similar hospital days and infection episodes. Nonvascular complications were more frequent in LDP owing to more fluid collections (43.0% vs. 21.9%, P = .04). The ISGPF grade B/C pancreatic fistula rates were similar (27.8% in LDP vs. 25.0% in LSPDP, P = .760). Vascular complications were more frequent in LSPDP (64.5% vs. 26.0%, P < .01). Excluding some fluid collections, none required a specific treatment. Late results demonstrated no differences in nonvascular results. Vascular complications were more frequent in LSPDP (65.6% vs. 4.2%, P < .01). The vascular complications did not require any specific treatment or have any serious sequelae. There was no overwhelming postsplenectomy infection. QoL and nutritional indices showed no difference. QoL decreased at discharge and recovered from 3 months thereafter. Nutritional indices showed a similar pattern.
  
  
  CONCLUSIONS
  LDP is associated with more fluid collections and LSPDP with more vascular complications, all with a minimal clinical impact. Both methods had similar functional outcomes. Either LDP or LSPDP could be performed depending on the indication and surgeon's experiences considering the comparable results.
authors.affiliation: 1 Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine , Seoul, Korea.|2 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea.
authors.forename: Wooil
authors.initials: W
authors.lastname: Kwon
authors.affiliation: 1 Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine , Seoul, Korea.
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
authors.affiliation: 3 Department of Radiology, Seoul National University College of Medicine , Seoul, Korea.
authors.forename: Jung Hoon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: 1 Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine , Seoul, Korea.
authors.forename: Ye Rim
authors.initials: YR
authors.lastname: Chang
authors.affiliation: 1 Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine , Seoul, Korea.
authors.forename: Woohyun
authors.initials: W
authors.lastname: Jung
authors.affiliation: 1 Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine , Seoul, Korea.
authors.forename: Mee Joo
authors.initials: MJ
authors.lastname: Kang
authors.affiliation: 1 Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine , Seoul, Korea.
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
mesh_terms: D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D061646:Operative Time; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D013154:Spleen / Q000601:surgery*; D016896:Treatment Outcome