Objective:To investigate the clinical efficacy of laparoscopic spleen-preserving distal pancreatectomy (Kimura method and Warshaw method) for benign lesions of pancreatic body and tail.
Methods: The retrospective cohort study was conducted. The clinicopathological data of 39 patients with benign lesions of pancreatic body and tail who underwent laparoscopic spleenpreserving distal pancreatectomy in the Second Affiliated Hospital of Nanchang University between March 2008 and January 2018 were collected. Of 39 patients,28 undergoing Kimura method (splenic artery and vein-preserving distal pancreatectomy) were allocated into the Kimura group, and 11 undergoing Warshaw method (cutting splenic vessels and preserving short gastric vessels) due to serious adhesion between pancreatic body and tail and splenic hilum were allocated into the Warshaw group. Observation indicators: (1) operation situations; (2) postoperative situations; (3) Follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect blood glucose level and tumor recurrence of patients up to March 2018. Measurement data with normal distribution were represented as
±s and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were described as M (range) and comparison between groups was done using nonparametric ranksum test. Comparisons of count data were analyzed using chisquare test or Fisher exact probability.
Results:(1) Operation situations: 39 patients received laparoscopic spleenpreserving distal pancreatectomy, operation time and volume of intraoperative blood loss of 39 patients were respectively (194 ±58)minutes and 100 mL (range, 30-800 mL). The operation time and volume of intraoperative blood loss were respectively (197±56)minutes, 100 mL (range, 30-800 mL) in the Kimura group and (186±63)minutes, 150 mL (range, 30-450 mL) in the Warshaw group, with no statistically significant difference between groups (t=0.494, Z=-0.597, P>0.05). (2) Postoperative situations: time to anal exsufflation and duration of hospital stay were respectively (2.6±0.8)days, (9.2±7.3)days in 39 patients and (2.4±0.6)days, (7.5±4.2)days in the Kimura group and (2.8±1.3)days, (13.5±11.1)days in the Warshaw group, with no statistically significant difference between groups (t=-0.720, -1.736, P>0.05). Seven patients had postoperative complications. The incidence of complication was 2/28 in the Kimura group, 1 patient with pancreatic leakage at 5 days postoperatively was cured by 15day B ultrasound guided catheter drainage, and 1 who was diagnosed as pulmonary infection by chest CT examination at 5 days postoperatively was discharged from hospital after 8day antiinfection and sputuminductive treatments. The incidence of complication was 5/11 in the Warshaw group, 3 patients with sustained fever at 5 and 7 days postoperatively who were diagnosed as grade 1 splenic infarction by epigastric enhanced CT examination were improved and discharged from hospital by antibiotic and low molecular weight heparin treatments, and then epigastric enhanced CT reexamination at 3 months postoperatively showed recovery of splenic perfusion; 1 with pancreatic leakage at 7 days postoperatively was cured by 18-day conservative treatment; 1 who was diagnosed as delayed gastric emptying by upper gastrointestinal contrast at 16 days postoperatively was improved and then discharged from hospital by 15day placement of intestinal feeding tube and nutrition support therapy. There were statistically significant differences in the incidences of overall complication and splenic infarction between groups (X
2=5.485, 4.878, P<0.05) and no statistically significant difference in the incidence of other complications between groups (P>0.05). (3) Follow-up situations: 39 patients were followed up for 12 months (range, 2- 64 months). During the Follow-up, six patients had normal blood glucose level, and all patients had good quality of life, without recurrence.
Conclusions:Laparoscopic spleenpreserving distal pancreatectomy for the benign lesions of pancreatic body and tail is satisfactory in short and longterm curative effects. The incidences of complication and splenic infarction of Kimura method are lower than that of Warshaw method.
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