| Contributors: |
Donisi, Greta; Capretti, Giovanni; Napoli, Niccolò; Partelli, Stefano; Esposito, Alessandro; Ferrari, Giovanni; Butturini, Giovanni; Morelli, Luca; Abu Hilal, Mohammad; Viola, Massimo; Di Benedetto, Fabrizio; Troisi, Roberto; Vivarelli, Marco; Jovine, Elio; Caputo, Damiano; Ferrero, Alessandro; Bracale, Umberto; Alfieri, Sergio; Casadei, Riccardo; Ercolani, Giorgio; Moraldi, Luca; Molino, Carlo; Dalla Valle, Raffaele; Ettorre, Giuseppe; Memeo, Riccardo; Zanus26, Giacomo; Belli, Andrea; Gruttadauria, Salvatore; Brolese, Alberto; Coratti, Andrea; Garulli, Gianluca; Romagnoli, Renato; Massani, Marco; Belli, Giulio; Falconi, Massimo; Salvia, Roberto; Boggi, Ugo; Zerbi, Alessandro |
| Description: |
Aim: Minimally invasive distal pancreatectomy has become the standard of care for benign and low malignant lesions. Spleen preservation in this setting has been proposed to reduce surgical trauma and long-term sequelae. The aim of the current study is to present real-world data on indications, techniques, and outcomes of spleen-preserving distal pancreatectomy (SPDP). Methods: Patients who underwent SPDP and distal pancreatectomy with splenectomy (DPWS) were extracted from the 2019-2022 Italian National Registry for Minimally Invasive Pancreatic Surgery (IGoMIPS). Perioperative and pathological data were collected. Results: One hundred and ten patients underwent SPDP and five hundred and seventy-eight underwent DPWS. Patients undergoing SPDP were significantly younger (56 vs. 63.5 years; P < 0.001). Seventy-six percent of SPDP cases were performed in six out of thirty-four IGoMIPS centers. SPDP was performed predominantly for Neuroendocrine Tumors (43.6% vs.23.5%; P < 0.001) and for smaller lesions (T1 57.6% vs. 29.8%; P < 0.001). The conversion rate was higher in the case of DPWS (7.6% vs. 0.9%; P = 0.006), even when pancreatic cancer was ruled out (5.0% vs. 0.9%; P = 0.045). The robotic approach was most commonly used for SPDP (50.9% vs. 29.7%; P < 0.001). No difference in postoperative outcomes and length of stay was observed between the two groups, as well as between robotic and laparoscopic approaches in the SPDP group. A trend toward a lower rate of postoperative sepsis was observed after SPDP (0.9% vs. 5.2%; P = 0.056). In 84.7% of SPDP, splenic vessels were preserved (Kimura procedure) without an impact on short-term postoperative outcomes. Conclusion: In this registry analysis, SPDP was feasible and safe. The Kimura procedure was prevalent over the Warshaw procedure. The typical patient undergoing SPDP was young with a neuroendocrine tumor at an early stage. Robotic assistance was used more frequently for SPDP than for DPWS. |