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.

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

Boggi, Ugo;Esposito, Alessandro;Ferrari, Giovanni;Pietrabissa, Andrea;White, Steve;
2021

Abstract

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.
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 V; 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
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11568/1142004
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