Analysis of Factors Determining Spleen Preservation during Laparoscopic Distal Pancreatectomy - A Cohort Study

Maciej Borys ¹, Michał Wysocki ¹, Krystyna Gałązka ²

⁰Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital, Cracow, Poland.

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques +

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July 19, 2024

View abstract on PubMed

Summary

Spleen preservation during laparoscopic distal pancreatectomy is feasible and safe. Tumor size over 3 cm is the main risk factor for unplanned splenectomy, which does not increase postoperative complications.

Area Of Science

Surgical Oncology
Gastrointestinal Surgery
Minimally Invasive Surgery

Background

Spleen preservation during laparoscopic distal pancreatectomy (LSPDP) is oncologically desirable when safe.
Evaluating outcomes and risk factors for splenectomy in LSPDP is crucial.

Purpose Of The Study

To compare surgical outcomes of spleen preservation versus splenectomy in LSPDP.
To identify risk factors for unplanned splenectomy during LSPDP.
To assess short- and long-term outcomes following LSPDP with or without splenectomy.

Main Methods

Retrospective cohort study of 106 patients undergoing LSPDP with spleen preservation intent.
Data collected from August 2012 to December 2022, with survival follow-up until January 2023.
Analysis included comparison of surgical outcomes and multivariate logistic regression for risk factors.

Main Results

Spleen preservation achieved in 63.2% of patients.
Larger tumor size (>3 cm) was associated with higher rates of unplanned splenectomy (OR 8.41).
No significant difference in overall serious postoperative morbidity or pancreatic fistula rates between spleen preservation and splenectomy groups.

Conclusions

Unplanned splenectomy during LSPDP does not elevate postoperative morbidity or pancreatic fistula risk.
Tumor size exceeding 3 cm is an independent predictor for requiring splenectomy during LSPDP.
Spleen preservation should be attempted in LSPDP when oncologically appropriate.