Extended left-sided pancreatectomy with spleen preservation

Background: Distal pancreatectomy (DP) is frequently performed with splenectomy, although splenectomy can be linked to various untoward effects, and sparing of the main splenic vessels (SVs) is not necessary for successful spleen preservation (SP). Methods: We reviewed all DPs in a single-surgeon practice to assess feasibility and outcomes of SP. Results: Between 1997 and 2007, 41 of 177 pancreatic resections involved a DP (23%). There were 14 men (34%) and 27 women (66%), with a median age of 60 years (range: 34-86). Four procedures were en bloc resections, two total pancreatectomies, while eight of the remaining 35 DPs were performed laparoscopically. SP was accomplished in 33 of 34 possible cases (SP rate 97%), despite SV resection in 27 of these (82%). The postoperative complication rate was 24%, without death. Pancreatic fistulae occurred in two patients (5% of patients at risk), and one SPDP led to splenic infarct. No other clinically relevant problems specific to SP have become apparent. Conclusions: Pancreatic fistula rate and other outcomes in this small DP experience compare favorably to other DP series. Few spleen-specific complications and the radicality of resection support the liberal use of SP with SV resection, irrespective of an open or laparoscopic approach.