Splenic vessels preserving versus Warshaw technique in spleen preserving distal pancreatectomy: A systematic review and meta-analysis

Abstract

Background: Spleen-preserving distal pancreatectomy is widely used to remove benign or low-grade malignant neoplasms located in the pancreatic body and tail. Both splenic vessels preserving (SVP-DP) and splenic vessels ligating (Warshaw technique [WT]) distal pancreatectomy are safe and effective methods but which technique is superior remains controversial. Thus, this study aimed to evaluate the clinical outcomes of patients who underwent both methods.

Material and methods: Major databases, including PubMed, Embase, Science Citation Index Expanded, and The Cochrane Library, were searched for studies comparing SVP-DP and the WT for spleen-preserving distal pancreatectomy up to December 2021. The perioperative and postoperative outcomes were compared between the SVP-DP and WT groups. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models.

Results: Twenty retrospective studies with 2173 patients were analyzed. A total of 1467 (67.5%) patients underwent SVP-DP, while 706 (32.5%) patients underwent WT. Patients in the SVP-DP group had a significantly lower rate of splenic infarction (OR: 0.17; 95% CI, 0.11-0.25; P < 0.00001) and incidence of gastric varices (OR: 0.19; 95% CI, 0.11-0.32; P < 0.00001) compared to the patients in the WT group; furthermore, they had a shorter length of hospital stay (WMD: 0.71; 95% CI, -1.13 to -0.29; P = 0.0008). There were no significant differences between the two groups in terms of major complication, postoperative pancreatic fistula (B/C), reoperation, blood loss, or operation time.

Conclusions: Compared to WT, SVP-DP should be preferred to reduce splenic infarction and gastric varices, and WT may be more suitable for large tumors. Moreover, considering the shortcomings of retrospective study, a multicenter randomized controlled study with a large sample size should be conducted to verify our results.

Keywords: Postoperative complications; Spleen-preserving distal pancreatectomy; Splenic vessels preservation; Warshaw technique.