[Distal pancreatectomy: radical or spleen-preserving?]

Area of Science:

• Surgical Oncology
• Gastroenterology
• Abdominal Surgery

Context:

• Spleen-preserving distal pancreatectomy (SPDP) is increasingly utilized in pancreatic surgery.
• The primary rationale involves preventing overwhelming postsplenectomy infection syndrome (OPSI) and potential carcinogenesis reduction.

Purpose:

• To compare spleen-preserving distal pancreatectomy (SPDP) with distal pancreatectomy with splenectomy (DPSx).
• To evaluate short-term and long-term outcomes, including surgical complications and oncological considerations.

Summary:

• SPDP and DPSx show similar short-term results regarding blood loss, operative time, mortality, and reoperation rates.
• Data on pancreatic fistulas and major surgical complications remain conflicting.
• Long-term effects like gastric varices due to portal hypertension need further study.

Impact:

• SPDP is recommended for benign pancreatic tail tumors and chronic pancreatitis.
• Resection of splenic vessels can be combined with SPDP if splenic blood supply is adequate.
• Distal pancreatectomy with splenectomy (DPSx) remains necessary for malignant tumors due to oncological principles.