Spleen‐preserving versus spleen‐sacrificing distal pancreatectomy in adults with blunt major pancreatic injury

• Published in: BJS open Vol. 2; no. 6; pp. 426 - 432
• Main Authors: Lin, B.‐C., Chen, R.‐J., Hwang, T.‐L.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.12.2018; Oxford University Press
• Subjects: Abdomen; Adults; Age; Contusions; Fistula; Hospitals; Injuries; Original; Pancreas; Pancreatectomy; Patients; Spleen; Surgeons; Surgery; Trauma
• ISSN: 2474-9842; 2474-9842
• DOI: 10.1002/bjs5.89

Background The aim of this study was to analyse outcomes of spleen‐preserving (SPDP) and spleen‐sacrificing (SSDP) distal pancreatectomy in adults with severe blunt pancreatic injuries. Methods This was an observational study of adult patients who underwent distal pancreatectomy for grade III or IV blunt pancreatic injury between 1991 and 2015. Outcomes of SPDP and SSDP were compared. Results Fifty‐one patients were included, of whom 23 underwent SPDP and 28 SSDP. The median Injury Severity Score (ISS) was 13·0 (i.q.r. 9·0–18·0). No significant differences were observed between the groups regarding sex, trauma mechanism, shock at triage, laboratory data, location, ISS, associated injury, length of stay, mortality or morbidity. Age (27·0 versus 36·5 years; P = 0·012) and time interval from injury to distal pancreatectomy (15·0 versus 44·0 h; P = 0·022) differed significantly between SPDP and SSDP groups respectively. The mortality rate was 4 per cent (1 of 23) versus 11 per cent (3 of 28) respectively (P = 0·617). Nine patients (39 per cent) developed abdominal morbidity after SPDP, compared with 17 (61 per cent) after SSPD (P = 0·125). In the SPDP group, eight patients had grade B postoperative pancreatic fistula (POPF), two of whom required further intervention. In the SSDP group, six of ten patients with grade B POPF required CT‐guided drainage, and a further five patients required reoperation for other causes. There were more reinterventions after SSDP: 11 of 28 (39 per cent) versus 3 of 23 (13 per cent) in the SPDP group (P = 0·037). Conclusion SPDP was performed more often in younger patients and at a shorter interval after severe blunt pancreatic injury. SPDP was associated with fewer reinterventions. For the management of grade III or IV blunt pancreatic injury, young age and early surgery were considered positive determining factors for spleen preservation when performing distal pancreatectomy. Early distal pancreatectomy could increase the chances of preserving the spleen; furthermore, splenic preservation results in a better patient outcome than splenic sacrifice. Preserving the spleen more likely in early surgical management