Application of a preoperative image scoring system in laparoscopic spleen-preserving distal pancreatectomy

A reasonable surgical plan is crucial to laparoscopic spleen-preserving distal pancreatectomy. This study proposed a preoperative image classification and scoring system, then evaluated the predictive value in creating a spleen-preserving strategy.

Data for patients who underwent laparoscopic spleen-preserving distal pancreatectomy at our hospital were collected from a prospective database. Clinical parameters and preoperative images were reviewed and analysed.

We included 58 cases, and patients underwent the Kimura procedure (n = 29) or the Warshaw procedure (n = 29). According to the relationship between the tumour and the splenic vein in preoperative images, we proposed an image classification constituting four types. In the univariate analysis, age, tumour size, length of the distal pancreas to the left of the tumour and the image classification were significantly associated with spleen-preservation methods. Multivariate analysis indicated that tumour size and image classifications were independent factors. We established a scoring system by combining these two factors and scored and classified patients into four groups as 0, 61, 100 and 161 points. The probabilities of spleen-preservation procedures corresponding to different points were then calculated.

This preoperative image classification and scoring system might be helpful when creating a spleen-preserving strategy during laparoscopic distal pancreatectomy.