Patency Of Splenic Vessels After Laparoscopic Splenic Vessel-preserving Distal Pancreatectomy

Objective:1. To investigate the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP).2. To evaluate splenic vascular patency and the function of spleen.Methods:From March2004to December2014, the patients who were scheduled to receive laproscopic distal pancreatectomy were included in this study. Exclusion criteria were pancreatic adenocarcinoma, conversion to laparotomy and Warshaw method. The patients were divided into two groups based on the surgical approach:the LSPDP group and the laparoscopic distal pancreatosplenectomy (LDPS) group. The safety and feasibility of LSPDP were investigated by comparing the short-term outcomes of the two groups. The function of spleen salvage was assessed by comparing White blood cell(WBC), Hemoglobin(Hgb), Platelet(PLT), C-reactive protein (CRP)and the patency of splenic vessels after LSPDP. In addition, all LSPDP patients were divided into two groups based on the vascular patence:A group(Grade0:intact) and B group(Grade1: partial occlusion or thrombosis).Results:Totally,119cases were included in this study, including59cases in the LSPDP group and60cases in the LDPS group. There were no significant differences between the two groups with respect to sex, age, BMI, symptoms, comorbidity, history of abdominal surgery and ASA status (P>0.05).Patients undergoing LSPDP had a shorter operative time(174.2±61.4min vs 193.9±54.4min), lower amount of intraoperative blood loss(116.4±150.9mlvs229.0±233.7ml, P=0.002). However, the difference in blood transfusion was not statistically significant (P>0.05)Patients undergoing LSPDP had a higher postoperative complication rates(72.9%vs53.3%, P=0.021), major complications rates(≥Grade Ⅲ)(10.2%vs10.0%, P>0.05), pancreatic fistula rates (28.8%vs21.7%,,P=0.469), bleeding rates (P=0.311), infection rates(P=0.445)between the two groups. There were no significant differences with respect to time to out-of-bed activity, first flatus, first liquid diet and postoperative hospital stay (P>0.05)On POD3, LDPS group had more cases of WBC≥10*109/L than the LSPDP group (76.7%vs23.7%, P=0.000). On POD14, LDPS group had more cases of PLT≥300*109/L than the LSPDP group (61.7%vs46.7%, P=0.000).Among59patients with LSPDP with Kimura were included. It was nomal in all of the preoperative patency of the splenic artery and vein.Normal patency of the splenic artery and vein was observed in44and41patients respectively within1month of surgery, and in50and46patients3months or more after operation. NO patient has complete splenic vein occlusion.A group and B group showed no difference in sex, age, BMI and so on. But the operate time (P=0.084) and the grade of postoperative complication (P=0.026) had statistically significant.Conclusion:1. LSPDP is a procedure as safe and feasible as LDPS.2. LSPDP can lower the grade of postoperative complication and complications of Hematologic System.3. the grade of postoperative complication is an influence factors of splenic vascular patency. And operate time can indirectly reacte the operation difficulty.