Resection of the Splenic Vessels during Laparoscopic Central Pancreatectomy Is Safe and Does Not Compromise Preservation of the Distal Pancreas

Abstract

Introduction: Laparoscopic central pancreatectomy (LCP) for non-malignant tumours, usually preserving splenic vessels (LCP-PreSV), allows a low-risk of new onset diabetes and high morbidity represented mainly by postoperative pancreatic fistula (POPF) and post-pancreatectomy haemorrhage (PPH). In this study, we evaluated the impact of the splenic vessels resection (LCP-ResSV) on short and long-term complications. Methods: This was a retrospective single center cohort study. Of 650 laparoscopic pancreatic resections from 2008 to 2020, 84 LCP with pancreatogastric anastomosis were performed. The 15 LCP-ResSV were matched [1:2] and compared with 30 LCP-PreSV according to age, sex, BMI and tumour characteristics. Results: In the LCP-ResSV, splenic vessels resection was performed related to tumoral or inflammatory adhesions (n=11) and accidental vascular injury (n = 4). In the LCP-ResSV group, the tumour size was larger (40 vs 21 mm;p=0.008) and the right transection more frequently performed on the body (53%vs13%; p=0.01). The median operative time (min) was longer (210vs180; p=0.15) with more blood loss (100 mLvs 50 mL; p=0.012), respectively. The lengths (mm) of the resected pancreas and remnant distal pancreas were 65 vs 50 (p=0.053) and 40 vs 65 (p=0.006), respectively. There were no significant differences regarding postoperative mortality (0%vs3%), grade B-C POPF (27%vs27%), re-intervention (7%vs13%), grade B-C PPH (0%vs13%), hospital stay (20vs22 days) and new onset diabetes (7%vs10%). Conclusion: LCP-ResSV is a safe technical modification of CP that does not compromise preservation of the distal pancreas with no impact on POPF or endocrine insufficiency, compared to LCP-PresSV. Furthermore, it could reduce the risk of PPH.