Splenic preservation in laparoscopic distal pancreatectomy

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Pancreatic Surgery

Background:

• Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is indicated for benign and low-grade malignant left pancreatic lesions.
• Comparison between LSPDP and laparoscopic distal pancreatectomy with splenectomy (LDPS) is crucial.
• Evaluating splenic preservation techniques (vessel preservation vs. Warshaw) and influencing factors is important.

Purpose of the Study:

• To compare the outcomes of LSPDP versus LDPS.
• To assess the efficacy of different splenic preservation methods.
• To identify predictors of successful splenic preservation in LSPDP.

Main Methods:

• Retrospective review of 206 patients undergoing laparoscopic distal pancreatectomy (2004-2016).
• Intention-to-treat and propensity score matching analyses were performed.
• Univariable and multivariable analyses identified factors affecting splenic preservation.

Main Results:

• LSPDP group had significantly shorter operative times (191.0 min) than LDPS group (220.5 min).
• Tumor size >3cm was an independent risk factor for splenic vessel resection.
• No significant splenic infarctions or gastrointestinal bleeding occurred post-LSPDP.

Conclusions:

• Planned LSPDP demonstrates a high splenic preservation rate and reduced operating time compared to LDPS.
• Splenic vessel preservation success can be predicted by tumor size, with a 3cm cutoff.
• LSPDP is a safe and effective procedure for selected pancreatic lesions.