In:
ANZ Journal of Surgery, Wiley, Vol. 88, No. 6 ( 2018-06)
Abstract:
Laparoscopic spleen‐preserving distal pancreatectomy for low‐grade malignant pancreas tumours was recently demonstrated and can be performed with splenic vessel preservation ( SVP ) or splenic vessel resection ( SVR ). Whether one approach is superior to another is still a matter of debate. Methods A systematic literature search (PubMed, Embase, Science Citation Index, Springer‐Link and Cochrane Central Register of Controlled Trials) was performed. Pooled intra‐ and post‐operative outcomes were evaluated. Stratified and sensitivity analyses were performed to explore heterogeneity between studies and to assess the effects of the study qualities. Results A total of six studies were included. There was no significant difference for SVR and SVP in terms of overall post‐operative complications and the pooled odds ratio ( OR ) was 0.87 (95% confidence interval ( CI ) 0.55–1.38, I 2 = 25%). Meta‐analysis on the pooled outcome of intraoperative operative time and blood loss favoured SVR ; the mean differences were 18.64 min (95% CI 6.91–30.37 min, I 2 = 21%) and 65.67 mL (95% CI 18.88–112.45 mL, I 2 = 48%), respectively. Subgroup analysis showed a decrease incidences in perigastric varices ( OR = 0.07, 95% CI 0.03–0.18, I 2 = 29%) and splenic infarction ( OR = 0.16, 95% CI 0.08–0.32, I 2 = 0%) in SVP . Conclusion For selected patients who underwent laparoscopic spleen‐preserving distal pancreatectomy, an increased preference for the SVP technique should be suggested considering its short‐term benefits. However, in case of large tumours that distort and compress vessel course, SVR could be applied with acceptable splenic ischaemia and perigastric varices.
Type of Medium:
Online Resource
ISSN:
1445-1433
,
1445-2197
DOI:
10.1111/ans.2018.88.issue-6
Language:
English
Publisher:
Wiley
Publication Date:
2018
detail.hit.zdb_id:
2095927-8
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