Total pancreatectomy for pancreatic malignancy with preservation of the spleen

Abstract

Background Total pancreatectomy may be necessary to achieve margin‐negative resection for pancreatic cancer. However, despite the desirability of saving the spleen, the feasibility, safety, and oncological outcomes of spleen‐preserving total pancreatectomy have not been studied in patients with malignancy involving the pancreatic neck or proximal body. The aim of this study was to report the efficacy of spleen‐preserving total pancreatectomy using the Warshaw technique for patients with pancreatic malignancies. Methods A retrospective analysis of patients who underwent total pancreatectomy for malignant pancreatic diseases between December 2006 and January 2018 focused on comparing the clinical outcomes between conventional operations with splenectomy and spleen‐preserving total pancreatectomy using the Warshaw technique. Results Thirty‐eight patients among a total of 59 total pancreatectomies had the spleen preservation by the Warshaw operation. In this series, the pancreatic ductal adenocarcinomas resected with the Warshaw technique were of smaller tumor size but had greater rates of vascular invasion, resulting in the more frequent vascular resection. No patients had splenic complications requiring splenectomy, but two patients intended to have the Warshaw operation were converted to splenectomy because of splenic malperfusion. Asymptomatic perigastric varices were noted in 4 patients. Postoperative morbidity and mortality were comparable between the Warshaw and conventional operation groups. Recurrence‐free and overall survival was similar in both groups. Conclusion In patients with pancreatic malignancy, total pancreatectomy with preservation of the spleen using the Warshaw technique achieves outcomes comparable with conventional total pancreatectomy with splenectomy in selected patients.

Pancreatectomy with Hepatic Artery Resection for Pancreatic Head Cancer

“…Adequate arterial and portal flow was confirmed to prevent postoperative ischemia-related complications. Other surgical procedures and perioperative management have been described previously [17][18][19][20].…”

Replaced right hepatic artery originated from splenic artery, in association with gastrosplenic trunk: a case report

“…The intraparenchymatous distribution of the hepatic artery proper (HAP) is homologated in specialized literature [ 1 , 2 , 3 , 4 ]. However, anatomic variants of hepatic arterial supply are frequently encountered during anatomical dissection, radiological intervention or surgical exploration.…”

“…With the accelerated development of liver transplant [ 10 ] and pancreatectomy [ 3 ] method and techniques, knowledge of the anatomical variations of aberrant hepatic arteries (accessories and replaced) increases its area of interest for planning and performing high-performance surgeries.…”

Feasibility and outcome of spleen and vessel preserving total pancreatectomy (SVPTP) in pancreatic malignancies — a retrospective cohort study

“…In most of the reported cases of spleen preserving DP, the splenic vessels are being resected according the "Warshaw-Procedure" [18,19] (i.e., central ligation of the splenic vessels with maintenance of the splenic perfusion via short vessels from the large gastric curvature).…”