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

摘要

Abstract 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.