Laparoscopic spleen-preserving distal pancreatectomy with and without splenic vessel preservation: The role of the Warshaw procedure |
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| Affiliation: | 1. Department of Inpatient, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China;2. Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China;1. Pancreatic Surgery Unit, San Raffaele Scientific Institute- Vita- Salute University, Milan, Italy;2. General Surgery Department, University of Perugia, Italy;3. Tift College of Education, Atlanta, Mercer University, USA;4. Digestive and Urgency Unit, Hospital of Terni, Italy;5. Division of Oncological and Robotic Surgery Careggi University Hospital, Florence, Italy;1. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;2. Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea |
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| Abstract: | Background/objectivesLaparoscopic spleen-preserving distal pancreatectomy (LSPDP) for low-grade malignant pancreas tumors was recently demonstrated. Although the procedure with splenic vessel preservation (SVP) is optimal for LSPDP, SVP is not always possible in patients with a large tumor or a tumor attached to splenic vessels. This study aimed to analyze the safety of two procedures: LSPDP without SVP, known as the Warshaw technique (lap-WT), and LSPDP with SVP (lap-SVP).MethodsSeventeen patients who underwent a lap-WT and seven patients who underwent a lap-SVP were investigated retrospectively.ResultsThe median follow-up duration was 45 (range 17–105) months. In the lap-WT and lap-SVP patients, the sizes of the tumors were 5 (1.3–12) and 1.5 (1–4) cm; the operative times were 304 (168–512) and 319 (238–387) min; the blood loss was 210 (5–3250) and 60 (9–210) gr; the length of the postoperative hospital stay was 15 (8–29) and 18 (5–24) days; the peak platelet counts were 37.2 (14.6–65.2) and 26.4 (18.8–41) × 104/μL, and splenomegaly was observed in 10 (59%) and three (43%) patients, respectively. In both procedures, there was no local recurrence. In the lap-WT group, splenic infarctions were seen in four (24%) patients and perigastric varices were seen in two (12%) patients. All of these patients were observed conservatively.ConclusionsBoth the lap-WT and lap-SVP were found to be safe and effective, and in cases in which the tumor is relatively large or close to the splenic vessels, lap-WT can be used as the more appropriate procedure. |
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| Keywords: | Pancreas tumor Splenic vessel preservation Laparoscopic distal pancreatectomy Warshaw technique Splenic infarction Splenomegaly |
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