Abstract
Central pancreatectomy (CP) is a well-described procedure done for neck and proximal body tumors of the pancreas. It can be done for benign lesions where an adequate length of normal distal pancreas will be left leading to organ preservation. The currently described benefit of the procedure is decreased long-term morbidity due to retention of both the spleen and the preservation of functioning pancreas. This is usually dependent on the preservation of distal pancreatic vascularity by splenic artery preservation. Many studies have described splenic preservation by Warshaw technique by safeguarding the short gastric (SGA) and left gastroepiploic (LGEA) vessels in case of distal pancreatectomy. However, distal pancreatic preservation during CP with splenic vessels ligation is not given a significant mention in the current literature in relation to Warshaw technique. Here, we present a 19-year-old girl diagnosed with an exophytic solid pseudopapillary tumor of the pancreatic body that was selected for central pancreatectomy. In view of splenic vessels involvement, she underwent ligation of the splenic vessels and splenic preservation was based on the LGEA and SGA. Distal pancreas was anastomosed with a roux en loop of jejunum and intra-operatively, we were able to demonstrate the back flow in the splenic vessels. Postoperative computed tomography showed adequate enhancement of the spleen along with retrograde blood flow into the distal splenic artery with enhancement of the distal pancreas. Her postoperative period went uneventful. Thus CP with extended Warshaw technique is a safe and feasible procedure where indicated.
Highlights
Central pancreatectomy (CP) is a parenchyma preserving pancreatic resection done in benign and low malignant lesions of pancreas
We present a 19-year-old girl diagnosed with an exophytic solid pseudopapillary tumor of the pancreatic body that was selected for central pancreatectomy
Splenic perfusion occurs by the retrograde blood supply via the short gastric and left gastroepiploic vessels and is well documented in Warshaw technique which is done for distal pancreatectomy [1]
Summary
Central pancreatectomy (CP) is a parenchyma preserving pancreatic resection done in benign and low malignant lesions of pancreas. Splenic perfusion occurs by the retrograde blood supply via the short gastric and left gastroepiploic vessels and is well documented in Warshaw technique which is done for distal pancreatectomy [1]. Further imaging evaluation with the contrast-enhanced computed tomography (CECT) abdomen showed an exophytic, well defined and encapsulated solid heterogeneously enhancing mass lesion arising from the body of pancreas pushing the stomach (Figure 1). How to cite this article Chinnakkulam Kandhasamy S, Sriram J K, Sahoo A K, et al (December 17, 2018) Distal Pancreas and Spleen-preserving Central Pancreatectomy in a Locally Aggressive Solid Pseudopapillary Neoplasm of Pancreas: A Novel Extended Warshaw Technique. The maintenance of adequate splenic and distal pancreatic blood supply was achieved by preserving the short gastric and the left gastroepiploic vessels. Aggressive features were identified including large tumor size (9 × 5 × 5 cm), focal capsular infiltration and perineural invasion
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