Effect of Spleen Preservation on the Occurrence of Sepsis in Patients Who Underwent Distal Pancreatectomy: A Population-Based, Propensity Score Matching Study

Background: To investigate the long-term effects of splenectomy on sepsis occurrence in patients undergoing distal pancreatectomy. Splenectomy is associated with sepsis and other severe infections. Splenic preservation has been advocated during distal pancreatectomy for benign or borderline pancreatic diseases. To date, no population-based study has investigated the risk of sepsis occurrence with regard to splenectomy in patients undergoing distal pancreatectomy. Methods: In this population-based study, the Health Insurance Review & Assessment Service (HIRA) database was used to identify patients who underwent distal pancreatectomy between 2010 and 2014. After propensity score matching, the variables that affect sepsis occurrence were analysed between the spleen-preserving distal pancreatectomy (SPDP) and the conventional distal pancreatectomy (CDP) groups. Findings: A total of 5,613 patients undergoing distal pancreatectomy were included in the HIRA database (2,560 splenectomised patients and 3,053 spleen-preserved patients). We matched 2,262 splenectomised patients to 2,262 spleen-preserved patients. No significant difference was observed in the rate of sepsis occurrence between the SPDP and CDP groups. Interpretation: Compared to spleen-preservation, splenectomy during distal pancreatectomy is not related to an increased likelihood of long-term sepsis. Thus, preservation of the spleen during distal pancreatectomy may not be mandatory in patients with benign pancreatic disease. However, further population-based studies are warranted to analyse the role of spleen-preserving distal pancreatectomy in other outcomes. Funding Information: This study received no financial support. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: This study was approved by institutional review board of Kangnam Sacred Heart Hospital (HKS 2018-11-013), and the need for informed consent from each patient was waived because the authors did not have access to identifiable information.