LAPAROSCOPIC DISTAL PANCREATECTOMY WITH OR WITHOUT SPLEEN PRESERVATION: COMPARATIVE ANALYSIS OF SHORT AND LONG-TERM OUTCOMES

ABSTRACT Background: Laparoscopic distal pancreatectomy (LDP) is the preferred approach for resection of tumors in the distal pancreas because of its many advantages over the open approach. Aim: To analyse and compare short and long-term outcomes from LDP performed through two different techniques: with splenectomy vs. spleen preservation and splenic vessel preservation. Method: Fifty-eight patients were operated and subsequently divided between two groups: Group 1, LDP with splenectomy (LDPS); and Group 2, LDP with spleen preservation and preservation of splenic vessels (LDPSPPSV). Results: The epidemiological characteristics were statistically similar between the two groups (age, gender, BMI and lesion size). Both the mean of operative time (p=0.04) and the mean of intra-operative blood loss (p=0,03) were higher in Group 1. The mean of resected lymph nodes was also higher in Group 1 (p<0.000). There were no statistic differences between the groups in relation to open conversion, morbidity or early postoperative mortality. The mean hospital stay was similar between groups. Pancreatic fistula (grade B and C) was similar between the groups. The mean of overall follow-up was 37.6 months (5-96). Late complications were similar between the groups. Conclusion: Both techniques were superimposable; however, LDPS presented, respectively, higher intra-operative bleeding, longer duration of the operation and higher number of lymph nodes resected. No differences were observed in the studied period in relation to the appearance of infections or neoplasm related to splenectomy during follow-up. Maintenance of the spleen avoided periodic immunizations in patients in LDPSPSV. It is indicated in small pancreatic lesions with indolent course.

摘要
背景：腹腔镜远端胰切除术（Laparoscopic distal pancreatectomy, LDP）是远端胰腺肿瘤切除术的首选术式，因其相较于开放手术具有诸多优势。
目的：旨在分析并对比两种不同术式下LDP的短期与长期结局：联合脾切除术的LDP与保留脾脏及脾血管的LDP。
方法：本研究纳入58例接受手术的患者，随后分为两组：组1为联合脾切除术的腹腔镜远端胰切除术（LDPS）；组2为保留脾脏及脾血管的腹腔镜远端胰切除术（LDPSPPSV）。
结果：两组患者的流行病学特征（年龄、性别、体重指数（Body Mass Index, BMI）、病灶大小）无统计学差异。组1的平均手术时间（p=0.04）与平均术中失血量（p=0.03）均更高。组1的平均清扫淋巴结数目也更多（p<0.000）。两组在中转开放手术率、并发症发生率或术后早期死亡率方面均无统计学差异。两组的平均住院时长相近。胰瘘（B级、C级）发生率亦无组间差异。总体平均随访时长为37.6个月（范围5~96个月）。两组的晚期并发症发生率相似。
结论：两种术式的整体结局相近；但LDPS的术中失血量更多、手术时长更长，且清扫的淋巴结数目更多。随访期间未观察到感染或与脾切除术相关的肿瘤相关并发症。采用保脾术式（LDPSPPSV）的患者无需接受周期性免疫接种。该术式适用于病程惰性的小型胰腺病灶。