Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta-analysis

Kohei Nakata, Satoru Shikata, Takao Ohtsuka, Tomohiko Ukai, Yoshihiro Miyasaka, Yasuhisa Mori, Vittoria Vanessa D.M. Velasquez, Yoshitaka Gotoh, Daisuke Ban, Yoshiharu Nakamura, Yuichi Nagakawa, Minoru Tanabe, Yatsuka Sahara, Kyoichi Takaori, Goro Honda, Takeyuki Misawa, Manabu Kawai, Hiroki Yamaue, Takanori Morikawa, Tamotsu KurokiYiping Mou, Woo Jung Lee, Shailesh V. Shrikhande, Chung Ngai Tang, Claudius Conrad, Ho Seong Han, Palanivelu Chinnusamy, Horacio J. Asbun, David A. Kooby, Go Wakabayashi, Tadahiro Takada, Masakazu Yamamoto, Masafumi Nakamura

Research output: Contribution to journalArticlepeer-review

46 Citations (Scopus)


Background: Minimally invasive distal pancreatectomy (MIDP) has gained in popularity recently. However, there is no consensus on whether to preserve the spleen or not. In this study, we compared MIDP outcomes between spleen-preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (DPS); as well as outcomes between splenic vessel preservation (SVP) and Warshaw's technique (WT). Methods: A systematic search of PubMed (MEDLINE) and Cochrane Library was conducted and the reference lists of review articles were hand-searched. Results: Fifteen relevant studies with 769 patients were selected for meta-analyses of DPS and SPDP, while another 15 studies with 841 patients were used for the analysis between SVP and WT. Compared with the DPS group, SPDP patients had significantly lower incidences of infectious complications (P = 0.006) and pancreatic fistula (P = 0.002), shorter operative time (P < 0.001), and less blood loss (P = 0.01). Compared with WT, SVP patients had significantly lower incidences of splenic infarction (P < 0.001) and secondary splenectomy (P = 0.003). Subanalysis for laparoscopic surgery alone had similar results. Conclusions: Based on this study, SPDP has significantly superior outcomes compared to DPS. When a spleen is preserved, SVP has better outcomes over WT for reducing splenic complications.

Original languageEnglish
Pages (from-to)476-488
Number of pages13
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Issue number11
Publication statusPublished - Nov 2018

All Science Journal Classification (ASJC) codes

  • Surgery
  • Hepatology


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