Spleen-preserving Laparoscopic Distal Pancreatectomy

Laparoscopic distal pancreatectomy (LDP) represents one of the mostadvanced applications for laparoscopic surgery currently in use. In the past,minimally invasive techniques in pancreatic surgery were only used for diagnosislaparoscopy, staging of pancreatic cancer. Now a growing number of case seriesand multi-insitutional reports on safety and efficacy of LDP. However, theprocedure should be attempted by surgeons who are experienced in laparoscopicsurgery. Distal pancreatectomy remains the only therapeutic option for patientswith benign and malignant neoplasms of the body and tail of the pancreas. Thespleen lies adjacent to the tail of the pancreas, and shares the same blood supply.Traditionally, splenectomy was done in conjunction with a distal pancreatectomy.Splenectomy may increase the risk of postoperative and life-long infectiouscomplications. In order to avoid splenectomy-associated complications, such asthe OPSI-syndrome or formation of abscesses in the splenic area, thespleen-preserving technique is more favorable. Due to ischemia caused by theresection of the splenic vessels, those vessels should remain untouched.Spleen-preserving laparoscopic distal pancreatectomy(SPLDP) cantechnically be more difficult because of the delicate dissection of the splenicvessels. We performed a retrospective review of30laparoscopic distalpancreatectomies. All the procedures were done laparoscopically without handassistance. Intraoperatively two cases were converted to open surgery because of peripancreatic organs involvement by cancer in one case and massivebleeding in another case during laparoscopic procedures. Attempts were made inall patients to conserve the spleen, which was successful in14patients. Patientswith spleen-preserving pancreatectomies had almost the same blood loss andoperative time compared with patients who underwent concomitant splenectomy.In the splenectomy group,7patients had8surgical complications (50%), Whichwas statistically significant compared with the spleen-preserving group, in whichthere were only3complications(21.6%). Splenic preservation should beattempted in all patients undergoing laparoscopic distal pancreatectomy unlessthere are overriding oncological or anatomic concerns.Owing to anatomic and other intraoperative factors during DP, the spleencannot always be preserved. However in this series, patients withspleen-preserving distal pancreatectomies had fewer complications, the sameoperating time and blood loss comparing with LDPS, including pancreatic fistula.Preservation of the splenic blood vessels may improve perfusion to the pancreaticstump and the function of the spleen. These findings support splenic preservationwhen possible during LDP.