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Laparoscopic spleen-preserving distal pancreatectomy with and without splenic vessel preservation: The role of the Warshaw procedure

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Title: Laparoscopic spleen-preserving distal pancreatectomy with and without splenic vessel preservation: The role of the Warshaw procedure
Authors: Matsushima, Hajime / Kuroki, Tamotsu / Adachi, Tomohiko / Kitasato, Amane / Hirabaru, Masataka / Hidaka, Masaaki / Soyama, Akihiko / Takatsuki, Mitsuhisa / Eguchi, Susumu
Issue Date: Nov-2014
Publisher: IAP and EPC
Citation: Pancreatology, 14(6), pp.530-535; 2014
Abstract: Background/objectives: Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for low-grade malignant pancreas tumors was recently demonstrated. Although the procedure with splenic vessel preservation (SVP) is optimal for LSPDP, SVP is not always possible in patients with a large tumor or a tumor attached to splenic vessels. This study aimed to analyze the safety of two procedures: LSPDP without SVP, known as the Warshaw technique (lap-WT), and LSPDP with SVP (lap-SVP). Methods: Seventeen patients who underwent a lap-WT and seven patients who underwent a lap-SVP were investigated retrospectively. Results: The median follow-up duration was 45 (range 17-105) months. In the lap-WT and lap-SVP patients, the sizes of the tumors were 5 (1.3-12) and 1.5 (1-4) cm; the operative times were 304 (168-512) and 319 (238-387) min; the blood loss was 210 (5-3250) and 60 (9-210) gr; the length of the postoperative hospital stay was 15 (8-29) and 18 (5-24) days; the peak platelet counts were 37.2 (14.6 -65.2) and 26.4 (18.8-41) × 104/μL, and splenomegaly was observed in 10 (59%) and three (43%) patients, respectively. In both procedures, there was no local recurrence. In the lap-WT group, splenic infarctions were seen in four (24%) patients and perigastric varices were seen in two (12%) patients. All of these patients were observed conservatively. Conclusions: Both the lap-WT and lap-SVP were found to be safe and effective, and in cases in which the tumor is relatively large or close to the splenic vessels, lap-WT can be used as the more appropriate procedure.
Keywords: Laparoscopic distal pancreatectomy / Pancreas tumor / Splenic infarction / Splenic vessel preservation / Splenomegaly / Warshaw technique
URI: http://hdl.handle.net/10069/35801
ISSN: 14243903
DOI: 10.1016/j.pan.2014.09.007
Rights: © 2014 IAP and EPC. Published by Elsevier, / NOTICE: this is the author’s version of a work that was accepted for publication in Pancreatology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Pancreatology, 14, 6, 2014
Type: Journal Article
Text Version: author
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/35801

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