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

Background: While outcomes after spleen-preserving distal pancreatectomy (SP-DP) are widely reported, the impact on splenic parenchyma is poorly studied. This study aimed to assess splenic imaging after SP-DP with splenic vessels removal or preservation, and to compare postoperative outcomes especially spleen-related. Methods: All patients undergoing 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: Ninety-five patients were included, 57 in WDP and 38 in KDP groups. The median age and Charlson’s Comorbidity Index were significantly higher in WDP group compared with KDP group. Postoperative morbidity was similar between groups. There was more splenic ischemia at early imaging in WDP compared to KDP groups (53% vs. 14%, p = 0.007), especially severe ischemia (22% vs. 0). Splenic partial atrophy was observed in 30% and 0% of WDP and KDP groups, respectively (p < 0.001); no complete splenic atrophy appeared. There was no significant difference between groups in haematological parameters (haemoglobin, platelets, white blood cells and CRP levels) until postoperative day 6. Charlson Comorbidity Index and postoperative day 6 platelets levels were prognostic factors of splenic atrophy at multivariate analysis. No episodes of overwhelming post-splenectomy infection or secondary splenectomy were recorded after a median follow-up of 9 and 11 months in 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 30% at late imaging, without clinical impact neither complete splenic atrophy. Charlson Comorbidity Index and postoperative day 6 platelets levels could help to predict the occurrence of splenic atrophy.