Short-Term Outcomes After Spleen-Preserving Minimally Invasive Distal Pancreatectomy With or Without Preservation of Splenic Vessels. Short-Term Outcomes After Spleen-Preserving Minimally Invasive Distal Pancreatectomy With or Without Preservation of Splenic Vessels: A Pan-European Retrospective Study in High-Volume Centers

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Korrel, Maarten | Lof, Sanne | Sarireh, Bilal Al | Björnsson, Bergthor | Boggi, Ugo | Butturini, Giovanni | Casadei, Riccardo | de Pastena, Matteo | Esposito, Alessandro | Fabre, Jean Michel | Ferrari, Giovanni | Fteriche, Fadhel Samir | Fusai, Giuseppe | Koerkamp, Bas Groot | Hackert, Thilo | D’hondt, Mathieu | Jah, Asif | Keck, Tobias | Marino, Marco | Molenaar, I. Quintus | Pessaux, Patrick | Pietrabissa, Andrea | Rosso, Edoardo | Sahakyan, Mushegh | Soonawalla, Zahir | Souche, Francois Regis | White, Steve | Zerbi, Alessandro | Dokmak, Safi | Edwin, Bjorn | Hilal, Mohammad Abu | Besselink, Marc

Edité par CCSD ; Lippincott, Williams & Wilkins -

International audience. OBJECTIVE: To compare short-term clinical outcomes after Kimura and Warshaw minimally invasive distal pancreatectomy (MIDP). BACKGROUND: Spleen preservation during distal pancreatectomy can be achieved by either preservation (Kimura) or resection (Warshaw) of the splenic vessels. Multicenter studies reporting outcomes of Kimura and Warshaw spleen-preserving MIDP are scarce. METHODS: Multicenter retrospective study including consecutive MIDP procedures intended to be spleen-preserving from 29 high-volume centers (≥15 distal pancreatectomies annually) in eight European countries. Primary outcomes were secondary splenectomy for ischemia and major (Clavien-Dindo grade ≥III) complications. Sensitivity analysis assessed the impact of excluding ('rescue') Warshaw procedures which were performed in centers that typically (>75%) performed Kimura MIDP. RESULTS: Overall, 1095 patients after MIDP were included with successful splenic preservation in 878 patients (80%), including 634 Kimura and 244 Warshaw procedures. Rates of clinically relevant splenic ischemia (0.6% vs. 1.6%, p = 0.127) and major complications (11.5% vs 14.4%, p = 0.308) did not differ significantly between Kimura and Warshaw MIDP, respectively. Mortality rates were higher after Warshaw MIDP (0.0% vs. 1.2%, p = 0.023), and decreased in the sensitivity analysis (0.0% vs 0.6%, p = 0.052). Kimura MIDP was associated with longer operative time (202 vs 184 min, p = 0.033) and less blood loss (100 vs 150 ml, p < 0.001) as compared to Warshaw MIDP. Unplanned splenectomy was associated with a higher conversion rate (20.7% vs 5.0%, p < 0.001). CONCLUSION: Kimura and Warshaw spleen-preserving MIDP provide equivalent short-term outcomes with low rates of secondary splenectomy and postoperative morbidity. Further analyses of long-term outcomes are needed.

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