Distal Pancreatectomy:Clinical Analysis Of70Cases

ObjectiveTo analyze the clinical data of distal pancreatectomy,to explore the feasibility and superiority of spleen-preserving distal pancreatectomy.MethodsThe clinical data of70patients who had been performed distal pancreatectomy in the Qilu Hospital of Shandong University during June2009to February2014were analyzed retrospectively, including28cases of spleen preserving distal pancreatectomy (SPDP, the spleen preserving group), and42cases of distal pancreatectomy with splenectomy (DP, the splenectomy group). Records were reviewed for data on demographic materials, intraoperative data, postoperative complications, pathological diagnoses, postoperative laboratory results, length of postoperative hospital stay etc.. Data were analysed using the Mann-Whitney U text, the Pearson chi-squared test, the Fisher’s exact test,and Logistic regression analyses. A P-value of<0.05was considered statistically significant.ResultsThe differences between the two groups on gender, medical history,complications and ASA score represented no statistical significance, while about age, the spleen preserving group (42.68±17.149y) was less than the splenectomy group (53.86±13.317y), the difference had statistical significance (P=0.005). The differences between the two groups on length of operation and surgical path represented no statistical significance. The intraoperative blood loss:the spleen preserving group (236.07±186.574ml) was less than the splenectomy group (373.81±335.275ml), the difference had statistical significance (P=0.031). Intraoperative blood transfusion:the spleen preserving group (7.1%,2/28) was less than the splenectomy group (26.2%,11/42), but the difference had no statistically significance (P=0.061). The pathological diagnosis showed statistically significant (P=0.002), wherein, the pancreatic cancer:the spleen preserving group (10.7%,3/28) was significantly less than the splenectomy group (40.5%,17/42), the difference had statistical significance(P=0.008), other types of pathology showed no statistical significance.The incidence of postoperative complications:the spleen preserving group (20.5%,7/28)was less than the splenectomy group (38.1%,16/42), but the difference showed no statistical significance(P=0.253). The incidence of postoperative infectious complications:the spleen preserving group (0.36%,1/28)was less than the splenectomy group (21.4%,9/42), the difference had statistical significance (P=0.043). The differences between the two groups on postoperative noninfectious complications represented no statistical significance. The length of postoperative hospital stay:the spleen preserving group (14.07±8.196d) was shorter than the splenectomy group (19.62±11.941d), the difference had statistical significance (P=0.024). The white blood cell count at the postoperative day7:the spleen preserving group((8.85±4.125)*10^9/L) was less than the splenectomy group ((11.76±3.141)*10^9/L), the difference had statistical significance (P=0.001). The platelet count at the postoperative day7:the spleen preserving group ((249.57±84.193)*10^9/L) was less than the splenectomy group ((526.14±181.409)*10^9/L), the difference had statistical significance (P=0.000). Blood transfusion was significantly associated with the occurrence of the postoperative pancreatic fistula as determined by multiple logistic.In addition,comparison of laparoscopic pancreatectomy vs open pancreatectomy with or without splenectomy, the laparoscopic group was associated with longer operative time(277.00±80.595min vs210.00±76.624min), the difference had statistical significance (P=0.013).The laparoscopic group was also associated with lower blood cell count((8.9310±2.12883)*10^9/L vs (10.8738±3.97845)*10^9/L), the difference had statistical significance(P=0.032).Conclusions1. Spleen preserving distal pancreatectomy is associated with smaller resection limits,less intraoperative blood loss, fewer infectious complications and shorter postoperative hospital stay, is a safe and effective procedure for treating the distal pancreatic tumors.2.Using WBC and platelet counts as markers, patients undergoing SPDP benefit from some preservation of splenic function. But the superiority needs to be validated in large cohort series and prospective randomized trials in the future.3.Blood transfusion were proved to be the independent risk factors correlated to postoperative pancreatic fistula.4.Laparoscopic distal pancreatectomy (LDP) with or without splenectomy for the treatment of distal pancreatic tumor is safe and feasible.