Effect of differences in precision vascular anatomy on surgical outcomes of distal pancreatectomy: a retrospective study

Abstract Background Minimally invasive distal pancreatectomy (MIDP) is increasingly performed worldwide; therefore, a better understanding of precision vascular anatomy during surgery is important. However, the effect of differences in precision vascular anatomy on surgical outcomes remains unclear. This study aimed to evaluate the effect of precision vascular anatomical variations on surgical outcomes and identify factors that influence open and minimally invasive surgery (MIS) outcomes. Methods This was a single-center retrospective study involving 123 patients who underwent distal pancreatectomy (DP). We analyzed the correlation between precision anatomical variations, namely, (i) the root of the splenic artery (SpA; type 1 and type 2), (ii) the parent artery of the dorsal pancreatic artery, (iii) confluence patterns of the left gastric vein, and (iv) the inferior mesenteric vein and surgical outcomes. We also performed a risk analysis of prolonged operation time, considering surgery-related factors. Results SpA type 2 was only significantly associated with longer operation time (p < 0.01) in DP procedures. In all DP cases, the pancreatic resection line (above the portal vein: odds ratio [OR] 3.47; 95% confidence interval [CI] 1.69–11.18; p < 0.01), SpA type (type 2; OR 2.77; 95% CI 1.16–6.94; p = 0.02), and surgery type (MIS; OR 5.24; 95% CI 2.17–14.00; p  24; OR 7.24; 95% CI 1.89–36.34; p < 0.01), tumor location (pancreatic body; OR 6.89; 95% CI 1.79–33.79; p < 0.01), and SpA type (type 2; OR 5.86; 95% CI 1.72–24.65; p < 0.01) showed significant association with prolonged operations. In MIDP cases, sex (male; OR 9.07; 95% CI 2.61–38.65; p < 0.001) and the pancreatic resection line (above the portal vein; OR 4.12; 95% CI 1.18–17.08; p = 0.03) showed significant associations. Conclusions SpA type 2 may affect surgical outcomes negatively. Therefore, recognizing and approaching precision vascular anatomy appropriately are important. MIS may be effective in mitigating the negative effects of variations in precision vascular anatomy.