The short-term outcomes of minimally invasive spleen-preserving distal pancreatectomy with splenic artery resection and splenic vein preservation: A comparative study with the Warshaw technique.

PURPOSE: Spleen-preserving distal pancreatectomy (SPDP) is performed for benign or low-grade malignant tumors of the pancreatic body and tail. The Warshaw technique (WT), involving the division of the splenic artery and vein, is associated with splenic infarction and gastric varices. Recently, SPDP with splenic artery resection and splenic vein preservation (SVP) has been introduced. However, its safety and feasibility remain unclear. This study compared the perioperative outcomes between the SVP and WT approaches.

METHODS

We retrospectively reviewed the data on patients who underwent laparoscopic or robot-assisted SPDP between January 2019 and December 2024. Of these, seven patients underwent SVP and 24 underwent WT. The clinical outcomes, complications, and postoperative imaging findings were evaluated.

RESULTS

The baseline characteristics were comparable between the groups. The operative time, blood loss, postoperative inflammatory markers, and clinically relevant postoperative pancreatic fistula showed no significant differences. Contrast-enhanced CT on postoperative day 7 demonstrated splenic infarction in 2 of 4 SVP patients (50%) and 14 of 22 WT patients (63.6%, p = 0.625). Gastric varices were observed only in the WT group (22.7%, p = 0.555). Splenic vein thrombosis did not occur in the SVP group.

CONCLUSIONS

The SVP approach is thus considered to be safe and feasible, with perioperative outcomes comparable to WT. Larger studies with long-term follow-up are warranted.