Distal pancreatectomy: en-bloc splenectomy vs spleen-preserving pancreatectomy

Abstract

Distal pancreatectomy with en-bloc splenectomy has been considered the standard technique for management of benign and malignant pancreatic disorders. However, splenic preservation has recently been advocated. The aim of this study was to review the experiences of distal pancreatectomy using the open or the laparoscopic approach and to critically discuss the need to perform splenectomy. Original articles published in the English literature of peer-reviewed medical journals were selected for detailed analysis. In patients with malignant neoplasms in the body-tail of the pancreas, splenectomy has a negative influence on long-term survival after resection. The incidence of diabetes after spleen-preserving distal pancreatectomy for chronic pancreatitis is less than after en-bloc splenectomy. Spleen salvage eliminates the risk of overwhelming infections. Laparoscopic spleen-preserving distal pancreatectomy is feasible and safe. Laparoscopic spleen-preserving distal pancreatectomy may be preferable for the advantages of a minimally invasive approach.

Figure 1.

Laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation.

Figure 2.

Laparoscopic spleen-preserving distal pancreatectomy without splenic vessel preservation. Care should be taken when transecting the splenic vessels at the splenic hilum to preserve the short gastric vessels and gastro-epiploic vessels.