Abstract
Purpose: Spleen-preserving surgical techniques combined with a minimally invasive approach have become increasingly common for benign or borderline malignant lesions of the pancreas. These more challenging procedures have immunologic advantages due to the maintenance of a functional spleen. The aim of this study was to evaluate the patency of the splenic vessels and splenic perfusion after spleen and splenic vessel-preserving distal pancreatectomy. Method: This retrospective single-centre study included all patients who underwent a spleen and splenic vessel-preserving distal pancreatectomy between April 2009 and October 2018. Patency of the vessels and splenic perfusion were assessed and classified based on computed tomography or magnetic resonance imaging. Results: Twenty-five patients underwent a spleen-preserving distal pancreatectomy of which 20 patients also had a splenic vessel-preserving surgery. The majority of the patients was operated with a minimal invasive technique (17 via laparoscopy or robot-assisted surgery and 3 via laparotomy). Five patients had no postoperative imaging. Normal patency of the splenic artery and vein was observed in 14 and 9 patients, respectively. Partial occlusion of the splenic vein was observed in 5 patients and total occlusion of the artery and vein was observed in 1 patient. Only 2 of these last 6 patients showed a limited infarction (< 50%) of the total splenic volume although without functional consequences. Conclusion: Spleen and splenic vessel-preserving distal pancreatectomy is safe and feasible. The patency of the splenic vessel is preserved in the majority of the patients and the perfusion of the spleen is also maintained, even when the splenic vessels are compromised.
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