Laparoscopic Spleen-Preserving Distal Pancreatectomy Splenic Vessel Preservation Compared With the Warshaw Technique

Objective: To compare preservation with the division of the splenic vessels in the surgical management of laparoscopic spleen-preserving distal pancreatectomy. Design: Bicentric retrospective study. Setting: Prospectively maintained databases. Patients: Between January 1997 and January 2011, 140 patients who underwent laparoscopic spleen-preserving distal pancreatectomy for benign or low-grade malignant tumors in the body/tail of the pancreas were included. Patients treated with the attempted splenic vessel preservation were compared with patients treated with the attempted division of the splenic vessels (Warshaw technique). Main Outcome Measures: Operative outcomes and postoperative morbidity were evaluated. Results: The outcomes of 55 patients in the splenic vessel preservation group were compared with those of 85 patients in the Warshaw technique group. The clinical characteristics were similar in both groups, except for tumor size, which was significantly greater in the Warshaw technique group (33.6 vs 42.5 mm; P<.001). The mean operative time, mean blood loss, and rate of conversion to the open procedure did not differ between the 2 groups. The rate of successful spleen preservation was significantly improved following the splenic vessel preservation technique (96.4% vs 84.7%; P=.03). Complications related to the spleen only occurred in the Warshaw technique group (0% vs 10.5%; P=.03), requiring a splenectomy in 4 patients (4.7%). The mean length of stay was shorter in the splenic vessel preservation group (8.2 vs 10.5 days; P=.01). Conclusions: The short-term benefits associated with the preservation of the splenic vessels should lead to an increased preference for this technique in selected patients undergoing laparoscopic spleen-preserving distal pancreatectomy for benign or low-grade malignant tumors in the body/tail of the pancreas. JAMA Surg. 2013; 148(3): 246-252. Published online November 19, 2012. doi: 10.1001/jamasurg.2013.768