A novel partial spleen-preserving distal pancreatectomy procedure: Comparison to the Warshaw technique.

Abstract

We evaluated a third spleen-preserving approach-indocyanine green-guided laparoscopic partial spleen-preserving distal pancreatectomy-for benign or low-grade pancreatic body/tail tumors, in comparison with the Warshaw technique. This was a single-center retrospective cohort study conducted between January 2020 and November 2024. Thirty-seven patients underwent laparoscopic partial spleen-preserving distal pancreatectomy (n = 15; preserving short gastric and superior polar vessels) versus Warshaw (n = 22). Intraoperative indocyanine green fluorescence was used to assess splenic perfusion. Outcomes included operative metrics, major morbidity (clinically relevant postoperative pancreatic fistula per International Study Group on Pancreatic Surgery 2016), radiologic splenic infarction, platelet counts, and health-related quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30). Operative duration (222.1 ± 39.5 minutes vs 208.2 ± 29.9 minutes; P = .23), blood loss (199.5 ± 25.8 mL vs 188.8 ± 29.1 mL; P = .31), and clinically relevant postoperative pancreatic fistula (13.6% vs 13.3%; P = 1.00) did not differ between the 2 groups. Laparoscopic partial spleen-preserving distal pancreatectomy yielded lower radiologic splenic infarction (0% vs 31.8%; P = .028) and lower platelet counts on postoperative day 7 (≈156 vs 218 × 10⁹/L; P = .01). Health-related quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) was assessed at baseline and at 1, 3, 6, and 12 months. Although overall trajectories were similar, global health status scores favored laparoscopic partial spleen-preserving distal pancreatectomy at 1 and 12 months (both P < .05). By conserving the short gastric and superior polar vessels with indocyanine green-guided perfusion mapping, Laparoscopic partial spleen-preserving distal pancreatectomy preserves viable splenic parenchyma, reducing splenic infarction and postoperative thrombocytosis without increasing operative time, blood loss, or clinically relevant postoperative pancreatic fistula. Laparoscopic partial spleen-preserving distal pancreatectomy represents a viable third spleen-preserving option that broadens minimally invasive, organ-preserving strategies for distal pancreatectomy.