Long term outcome after minimally invasive and open Warshaw and Kimura techniques for spleen-preserving distal pancreatectomy: International multicenter retrospective study. Issue 9 (September 2019)

• Record Type: Journal Article
• Authors: Paiella, Salvatore; De Pastena, Matteo; Korrel, Maarten; Pan, Teresa Lucia; Butturini, Giovanni; Nessi, Chiara; De Robertis, Riccardo; Landoni, Luca; Casetti, Luca; Giardino, Alessandro; Busch, Olivier; Pea, Antonio; Esposito, Alessandro; Besselink, Marc; Bassi, Claudio; Salvia, Roberto
• Is Part Of: European journal of surgical oncology. Volume 45:Issue 9(2019)
• Page Start: 1668
• Page End: 1673
• Publication Date: 2019-09
• Subjects: Parenchyma-sparing pancreatic resection -- Spleen-preserving pancreatectomy -- Pancreatic neuroendocrine tumor -- Minimally invasive pancreatic resection -- Pancreatic resection; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2019.04.004
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Background: The Warshaw (WT) and the Kimura (KT) techniques are both used for open or minimally invasive (MI) spleen preserving distal pancreatectomy (SPDP). Multicenter studies on long-term outcome of WT and KT are lacking. Methods: Multicenter retrospective study with transversal follow-up moment, including patients who underwent SPDP from 2000 to 2017 at three high-volume centers in Italy and the Netherlands. Primary endpoint was the incidence of short and long term complications. Patients without regular follow-up were interviewed about symptoms and complications. Results: In total, 164 patients were enrolled, 55 WT (33.5%) and 109 kT (66.5%), of which 95 (57.9%) MI. There was no 30-day mortality (0%).The only significant difference in short-term outcome was more delayed gastric emptying (DGE) after WT (9.1% vs 1.8%, p = 0.043). MI-SPDP was associated with less blood loss (median 150 vs 250 ml, respectively, p < 0.001), less DGE (0% vs 10%, p = 0.002), less abdominal abscesses (8.4% vs 18.4%, p = 0.03) and less splenic infarctions (3.2% vs. 13%, p = 0.042), than open SPDP. Long-term follow-up (median 41 months) was available for 111 patients (67.7%) of whom 18 (16.2%) had an SPDP-related long-term sequela, mostly perigastric varices (n = 11, 9%) but without differences between WT and KT. Less long-term sequelae were reported after MI as compared to open SPDP (12.5% vs 21.2%, p = 0.032). Conclusions: In this international retrospective study, the WT and KT had comparable short- and long-term outcomes. If a KT does not seem feasible during SPDP, a WT is recommended, rather than performing a splenectomy. MI-SPDP was associated with less short- and long term complications as compared to an open SPDP.