Indications and techniques for minimally invasive spleen-preserving distal pancreatectomy

Spleen-preserving distal pancreatectomy (SPDP) has gained increasing attention as a safe and effective alternative to distal pancreatectomy with splenectomy, particularly for benign and low-grade malignant lesions of the pancreatic body and tail. This narrative review evaluates the current evidence, technical considerations, and disease-specific indications for SPDP. Literature was reviewed using up to date scientific evidence and most recent national and international guidelines. Studies addressing SPDP outcomes, splenectomy complications, and disease-specific oncologic principles were included. Spleen preservation has been associated with reduced rates of postoperative infections, thromboembolic events, and long-term immunologic compromise, without compromising oncologic outcomes in selected patients. Indications favoring SPDP include pancreatic neuroendocrine tumors, intraductal papillary mucinous neoplasms, and solid pseudopapillary neoplasms. Although current guidelines generally recommend splenectomy for pancreatic ductal adenocarcinoma, emerging data suggest that spleen preservation may be feasible in highly selected cases. Technical approaches-primarily the Kimura and Warshaw techniques-enable safe dissection and splenic vessel management, particularly with the support of minimally invasive platforms. In conclusion, SPDP should be considered in appropriately selected patients to reduce morbidity while preserving long-term immune function. Future randomized studies are warranted to define oncologic safety and refine indications across tumor types.