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. 2023 Aug 21;23(1):245.
doi: 10.1186/s12893-023-02133-0.

Spleen-preserving pancreatectomy with removal of splenic vessels: impact on splenic parenchyma ?

Coralie Lete  1 , Martin Brichard  2 , Maria Luisa Rosa  3 , Mike Salavracos  4   5 , Catherine Hubert  2 , Benoit Navez  2 , Jean Closset  1 , Martina Pezzullo  3 , Julie Navez  6
Affiliations

Spleen-preserving pancreatectomy with removal of splenic vessels: impact on splenic parenchyma ?

Coralie Lete et al. BMC Surg. .

Abstract

Background: While outcomes after spleen-preserving distal pancreatectomy (SP-DP) have been widely reported, impacts on splenic parenchyma have not been well studied. This study aimed to compare postoperative outcomes, particularly spleen-related outcomes, by assessing splenic imaging after SP-DP with or without splenic vessels removal.

Methods: Data for all patients who underwent SP-DP with splenic vessels removal (Warshaw technique, WDP) or preservation (Kimura technique, KDP) between 2010 and 2022 in two tertiary centres were retrospectively analysed. Splenic ischemia and volume at early/late imaging and postoperative outcomes were reviewed.

Results: Eighty-seven patients were included, 51 in the WDP and 36 in the KDP groups. Median Charlson's Comorbidity Index was significantly higher in the WDP group compared with the KDP group. Postoperative morbidity was similar between groups. There was more splenic ischemia at early imaging in the WDP group compared to the KDP group (55% vs. 14%, p = 0.018), especially severe ischemia (23% vs. 0%). Partial splenic atrophy was observed in 29% and 0% in the WDP and KDP groups, respectively (p = 0.002); no complete splenic atrophy was observed. Platelet levels at POD 1, 2 and 6 were significantly higher in the WDP group compared to KDP group. At univariate analysis, age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction were prognostic factors for development of splenic atrophy. No episodes of overwhelming post-splenectomy infection or secondary splenectomy were recorded after a median follow-up of 9 and 11 months in the WDP and KDP groups, respectively.

Conclusions: Splenic ischemia appeared in one-half of patients undergoing SP-DP with splenic vessels removal at early imaging, and partial splenic atrophy in almost 30% at late imaging, without clinical impact or complete splenic atrophy. Age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction could help to predict the occurrence of splenic atrophy.

Keywords: Distal pancreatectomy; Spleen preservation; Splenic ischemia; Splenic vessels; Splenic volume.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Evolution of biological parameters the day before surgery (-1) and at postoperative days 1, 2, 4, 6 and 30 in the WDP and KDP groups: haemoglobin levels (a), leucocyte counts (b), platelet counts (c), and CRP levels (d). A significant difference between groups (p < 0.050) has been marked with a (*) WDP, Warshaw distal pancreatectomy; KDP, Kimura distal pancreatectomy; CRP, C-reactive protein
See this image and copyright information in PMC

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