Dynamic hematological changes in patients undergoing distal pancreatectomy with or without splenectomy: a population-based cohort study

Springer Science and Business Media LLC - 2020
Ming Cui1, Jingkai Liu1, Bang Zheng2, Qiaofei Liu1, Lu Zhang3, Li Zhang4, Junchao Guo1, Menghua Dai1, Taiping Zhang1, Quan Liao1
1Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
2School of Public Health, Faculty of Medicine, Imperial College London, London, W6 8RP, UK
3Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
4Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

Tóm tắt

Abstract Background The clinical outcomes of patients who received distal pancreatectomy with splenectomy (DPS) and spleen-preserving distal pancreatectomy (SPDP) have been generally investigated. However, postoperative hematological changes after distal pancreatectomy with or without splenectomy are poorly understood. Methods Information from patients undergoing distal pancreatectomy (DP) between January 2014 and June 2019 at a single institution was reviewed. A linear mixed-effects model was used to compare dynamic hematological changes between different groups. Results A total of 302 patients who underwent DP were enrolled. In the long term, most postoperative hematological parameters remained significantly higher than preoperative levels in the DPS group, while postoperative lymphocyte, monocyte, basophil, and platelet levels returned to preoperative levels in the SPDP group. All postoperative hematological parameters except for red blood cell count and serum hemoglobulin level were significantly higher in the DPS group than in the SPDP group. There were no significant differences in hematological changes between the splenic vessel preservation (SVP) and Warshaw technique (WT) groups. Conclusions Postoperative hematological changes were significantly different between the DPS and SPDP groups. Compared to DPS, SPDP reduced abnormal hematological changes caused by splenectomy. SVP and WT were comparable in terms of postoperative hematological changes.

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Tài liệu tham khảo

Dai MH, Shi N, Xing C, Liao Q, Zhang TP, Chen G, et al. Splenic preservation in laparoscopic distal pancreatectomy. Br J Surg. 2017;104:452–62.

Ferrone CR, Konstantinidis IT, Sahani DV, Wargo JA, Fernandez-del Castillo C, Warshaw AL. Twenty-three years of the Warshaw operation for distal pancreatectomy with preservation of the spleen. Ann Surg. 2011;253:1136–9.

Kimura W, Yano M, Sugawara S, Okazaki S, Sato T, Moriya T, et al. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein: techniques and its significance. J Hepatobiliary Pancreat Sci. 2010;17:813–23.

Gerry JM, Poultsides GA. Surgical management of pancreatic cysts: a shifting paradigm toward selective resection. Dig Dis Sci. 2017;62:1816–26.

Wu W, Jin G, Li H, Miao Y, Wang C, Liang T, et al. The current surgical treatment of pancreatic neuroendocrine neoplasms in China: a national wide cross-sectional study. J Pancreatol. 2019;2:35–42.

Rubin LG, Schaffner W. Clinical practice. Care of the asplenic patient. N Engl J Med. 2014;371:349–56.

Kristinsson SY, Gridley G, Hoover RN, Check D, Landgren O. Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up. Haematologica. 2014;99:392–8.

Kuroki T, Kitasato A, Tokunaga T, Takeshita H, Taniguchi K, Maeda S, et al. Predictors of portal and splenic vein thrombosis after laparoscopic splenectomy: a retrospective analysis of a single-center experience. Surg Today. 2018;48:804–9.

Shi N, Liu SL, Li YT, You L, Dai MH, Zhao YP. Splenic preservation versus splenectomy during distal pancreatectomy: a systematic review and meta-analysis. Ann Surg Oncol. 2016;23:365–74.

Moekotte AL, Lof S, White SA, Marudanayagam R, Al-Sarireh B, Rahman S, et al. Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study. Surg Endosc. 2020;34:1301–9.

Llende M, Santiago-Delpín EA, Lavergne J. Immunobiological consequences of splenectomy: a review. J Surg Res. 1986;40:85–94.

Djaldetti M, Bergman M, Salman H, Cohen AM, Fibach E, Bessler H. On the mechanism of post-splenectomy leukocytosis in mice. Eur J Clin Invest. 2003;33:811–7.

Bessler H, Bergman M, Salman H, Beilin B, Djaldetti M. The relationship between partial splenectomy and peripheral leukocyte count. J Surg Res. 2004;122:49–53.

Rab MAE, Meerveld-Eggink A, van Velzen-Blad H, van Loon D, Rijkers GT, de Weerdt O. Persistent changes in circulating white blood cell populations after splenectomy. Int J Hematol. 2018;107:157–65.

Warshaw AL. Conservation of the spleen with distal pancreatectomy. Arch Surg. 1988;123:550–3.

Kimura W, Inoue T, Futakawa N, Shinkai H, Han I, Muto T. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Surgery. 1996;120:885–90.

Tezuka K, Kimura W, Hirai I, Moriya T, Watanabe T, Yano M. Postoperative hematological changes after spleen-preserving distal pancreatectomy with preservation of the splenic artery and vein. Dig Surg. 2012;29:157–64.

Dragomir RM, Hogea MD, Moga MA, Festila DG, Cobelschi CP. Predictive factors for platelet count variation after splenectomy in non-traumatic diseases. J Clin Med. 2019;8:82.

Paiella S, De Pastena M, Korrel M, Pan TL, Butturini G, Nessi C, et al. Long term outcome after minimally invasive and open Warshaw and Kimura techniques for spleen-preserving distal pancreatectomy: International multicenter retrospective study. Eur J Surg Oncol. 2019;45:1668–73.

Weng J, Brown CV, Rhee P, Salim A, Chan L, Demetriades D, et al. White blood cell and platelet counts can be used to differentiate between infection and the normal response after splenectomy for trauma: prospective validation. J Trauma. 2005;59:1076–80.

Lathouras K, Panagakis G, Bowden SJ, Saliaris K, Saso S, Haidopoulos D, et al. Diagnostic value of post-operative platelet-to-white blood cell ratio after splenectomy in patients with advanced ovarian cancer. Int J Gynecol Cancer. 2019;29:1292–7.

Maatman TK, Butler JR, Quigley SN, Loncharich AJ, Crafts T, Ceppa EP, et al. Leukocytosis after distal pancreatectomy and splenectomy as a marker of major complication. Am J Surg. 2019. https://doi.org/10.1016/j.amjsurg.2019.12.004 .

Kristinsson S, Gridley G, Hoover R, Chech D, Landgren O. Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up. Haematologica. 2014;99:392–8.

Li Z, Lian B, Chen J, Song D, Zhao Q. Systematic review and meta-analysis of splenectomy in gastrectomy for gastric carcinoma. Int J Surg. 2019;68:104–13.

Pei Y, Zhang Z, Mba’nbo-Koumpa AA, Chen X, Zhang W. Improved survival following splenectomy combined with curative treatments for hepatocellular carcinoma in child B patients: a propensity score matching study. Hepatol Res. 2019;49:177–88.

Sahara K, Tsilimigras DI, Moro A, Mehta R, Dillhoff M, Heidsma CM, et al. Long-term outcomes after spleen-preserving distal pancreatectomy for pancreatic neuroendocrine tumors: results from the US neuroendocrine study group. Neuroendocrinology. 2020. https://doi.org/10.1159/000506399 .

Prehn RT. The paradoxical effects of splenectomy on tumor growth. Theor Biol Med Model. 2006;3:23.

Stöth M, Freire Valls A, Chen M, Hidding S, Knipper K, Shen Y, et al. Splenectomy reduces lung metastases and tumoral and metastatic niche inflammation. Int J Cancer. 2019;145:2509–20.

Hwang HK, Murakami T, Kiyuna T, Kim SH, Lee SH, Kang CM, et al. Splenectomy is associated with an aggressive tumor growth pattern and altered host immunity in an orthotopic syngeneic murine pancreatic cancer model. Oncotarget. 2017;8:88827–34.

Feng L, Gu S, Wang P, Chen H, Chen Z, Meng Z, et al. White blood cell and granulocyte counts are independent predictive factors for prognosis of advanced pancreatic cancer. Gastroenterol Res Pract. 2018;2018:8096234.

de la Fuente J, Sharma A, Chari S, Majumder S. Peripheral blood monocyte counts are elevated in the pre-diagnostic phase of pancreatic cancer: a population based study. Pancreatology. 2019;19:1043–8.

Navez J, Marique L, Hubert C, Van Laethem JL, Komuta M, Maris C, et al. Distal pancreatectomy for pancreatic neoplasia: is splenectomy really necessary? A bicentric retrospective analysis of surgical specimens. HPB (Oxford). 2020. https://doi.org/10.1016/j.hpb.2020.01.016 .

Collard M, Marchese T, Guedj N, Cauchy F, Chassaing C, Ronot M, et al. Is routine splenectomy justified for all left-sided pancreatic cancers? Histological reappraisal of splenic hilar lymphadenectomy. Ann Surg Oncol. 2019;26:1071–8.

Scoggins CR. Splenic preservation just might be reasonable for patients with left-sided pancreatic cancer. Ann Surg Oncol. 2019;26:924–5.

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