Resection of the splenic vessels during laparoscopic central pancreatectomy is safe and reduces the risk of post-operative haemorrhage

Abstract

Purpose: Low potential malignant diseases are more frequently discovered and laparoscopic central pancreatectomy (LCP) can be indicated. LCP usually preserving splenic vessels (LCP-PreSV), allows a low-risk of new onset diabetes at the expense of a high morbidity represented mainly by post-operative pancreatic fistula (POPF) and bleeding. In this study, we evaluated the impact of the splenic vessels resection (LCP-ResSV) on short and long term complications. Methods: Of 650 laparoscopic pancreatic resections from 2011 to 2020, 84 LCP were performed, including 15 LCP-ResSV and 69 LCP-PreSV. The 15 CPL-ResSV were matched [1:2] with 30 CPL-PreSV according to age, sex, BMI and tumor characteristics (neuroendocrine tumor, mucinous cystadenoma, intraductal papillary mucinous neoplasm, solid pseudopapillary neoplasm, cyst, others). Pancreatogastric anastomosis was achieved in all patients and patients were discharged after healing of complications. Both groups (LCP-ResSV vs LCP-PreSV) were compared. Results: In the LCP-ResSV, splenic vessels resection were performed related to tumoral or inflammatory adhesions (n=11) and accidental vascular injury (n = 4). There was no difference regarding demographics data. The tumour size was larger in LCP-ResSV (40mm vs 21mm; p = 0.008) and the right transection was more frequently done on the body (53% vs 13%; p=0.01). There was no difference in pancreatic characteristics (Wirsung duct size and consistency). The median operative time was longer in LCP-ResSV group (210 min vs 180 min ; p=0.15) with more blood loss (100 mL vs 50 mL ; p=0.012). The lengths (mm) of the resected pancreas and remnant distal pancreas were 65mm vs 50mm (p=0.053) and 40mm vs 65mm (p=0.006), respectively. There were no differences regarding post-operative mortality (0% vs 3% ; p = 0.47), grade B-C POPF (27% vs 27% ; p = 1), re-intervention (7% vs 13% ; p = 0.50); grade B-C bleeding (0% vs 13%; p = 0.13), length of hospital stay (20 days vs 22 days; p = 0.15) and new onset diabetes (7% vs 10%; p = 0.67). Conclusion: LCP-ResSV is a safe technical modification of central pancreatectomy with no impact on pancreatic fistula risk or endocrine insufficiency, compared to LCP-PreSV. Furthermore, it could reduce the risk of post-operative haemorrhage.