Splenic vessel preservation versus Warshaw's technique during spleen-preserving distal pancreatectomy: a meta-analysis and systematic review

Splenic preservation can be achieved through splenic vessel resection by Warshaw's technique (WT) or by preserving the splenic vessels. This meta-analysis aims to provide evidence-based comparison regarding the perioperative outcome and long-term benefits between patients with and without splenic vessel preservation (SVP) during spleen-preserving distal pancreatectomy. A meta-analysis was performed to evaluate studies comparing splenic vessel preservation versus resection groups. Ten retrospective studies including 699 patients were eligible for an analysis of general, perioperative, and long-term outcomes. A further analysis composed of five subgroups was also conducted in terms of laparoscopic approach. Warshaw's technique related to significant shorter operation time (P < 0.0001). There was no difference in blood loss (P = 0.45) as well as median tumor size (p = 0.1) between the two groups. The overall rate of complications indicated no difference between SVP and WT (P = 0.1), including pancreatic fistula rates, which were not statistically different among the treatment groups (P = 0.27). However, the occurrence of gastric varices and splenic infarction was significant higher in the WT group (P < 0.01). In laparoscopic subgroups, patients treated by WT had much lower blood loss (P = 0.002). In spleen-preserving distal pancreatectomy, comparing with SVP, there is no evidence of significant benefit of WT. Nonetheless, surgeons should master both techniques and choose an appropriate one based on personal experience and a "case by case" situation. However, the current available evidence is weak, and further randomized controlled data are warranted.