The management of pancreatic tail during robotic-assisted spleen-preserving left-sided pancreatectomy.

BACKGROUND

The anatomical relationship between the pancreatic tail and splenic vessels influences both pancreatic resection completeness and spleen preservation success in robotic spleen-preserving left-sided pancreatectomy (RSPLP). However, surgical strategies for managing the pancreatic tail during RSPLP remain unreported.

METHODS

Clinical data from 46 consecutive patients undergoing robot-assisted left-sided pancreatectomy with intended spleen preservation were analyzed. Pancreatic tails were classified into four anatomical types (I-IV) based on their relationship with splenic vessels or tumors.

RESULTS

The RLP group (spleen preservation failure) exhibited a higher proportion of type IV anatomy than the RSPLP group (spleen preservation success) (76.92 % vs. 18.18 %, P < 0.05). Type III/IV anatomy was associated with significantly lower spleen preservation rates (52.17 % vs. 91.30 %, P = 0.003), larger tumor size [4.0 (3.5-5.8) vs. 2.8 (2.2-4.6) cm, P = 0.026], greater intraoperative blood loss [134 (58-295) vs. 85 (45-180) mL, P = 0.017], and longer operative time (257.3 ± 62.29 vs. 220.78 ± 53.05 min, P = 0.038) compared to type I/II.

CONCLUSION

We proposed the preoperative classification of pancreatic tail type and the "pendulum separation" technique, and found that it was challenging to preserve the spleen in type III and IV pancreatic tails due to their complex anatomical relationship with the splenic vessel and tumor.