Ann Hepatobiliary Pancreat Surg.  2025 May;29(2):177-186. 10.14701/ahbps.24-202.

Outcome after spleen-preserving distal pancreatectomy by Warshaw technique for pancreatic body cancer

• Zhou E
• Shi G
• Shi H
• Zhang K
• Wei J
• Tu M
• Lu Z
• Guo F
• Chen J
• Jiang K
• Gao W

• KMID: 2568266
• DOI: http://doi.org/10.14701/ahbps.24-202

Abstract

Backgrounds/Aims
Distal pancreatectomy with splenectomy (DPS) is a common surgical procedure for pancreatic body cancer. However, spleen-preserving distal pancreatectomy (SPDP) utilizing the Warshaw technique (WT) in malignancies is generally not favored due to concerns about inadequate resection. This study aims to assess the feasibility and oncologic outcomes of employing SPDP with WT in pancreatic body cancer.
Methods
We conducted a retrospective analysis comparing 21 SPDP patients with 63 DPS patients matched by propensity score from January 2018 to November 2022. Clinical outcomes and follow-up data were analyzed using R.
Results
Both groups exhibited similar demographic, intraoperative, and pathological characteristics, with the exception of a reduced number of total lymph nodes (p = 0.006) in the SPDP group. There were no significant differences in the rates of postoperative complications, recurrence, or metastasis. Local recurrence predominantly occurred in the central region as opposed to the spleen region. There were no cases of isolated recurrences in the splenic region. Median overall survival and recurrence-free survival times were 51.5 months for SPDP vs 30.5 months for DPS and 18.7 months vs 16.8 months, respectively (p > 0.05). The incidence of partial splenic infarction and left-side portal hypertension in the SPDP group was 28.6% (6/21) and 9.5% (2/21), respectively, without necessitating splenic abscess puncture, splenectomy, or causing bleeding from perigastric varices.
Conclusions
SPDP did not negatively impact local recurrence or survival rates in selected pancreatic body cancer patients. Further studies are necessary for validation.

Keyword

Pancreatic body cancer; Distal pancreatectomy; Spleen preserving; Warshaw technique

Figure

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  Fig. 1 The scatter plot illustrates the total number of lymph nodes harvested in two groups. (**p < 0.01). SPDP, spleen-preserving distal pancreatectomy; DPS, distal pancreatectomy with splenectomy.

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  Fig. 2 Images depict the sites of local recurrence for six patients who underwent postoperative CT/PET-CT examinations in our hospital in the SPDP group (purple: recurrence, green: metastasis): All cases exhibited central region recurrence. Case 1 had a spleen region recurrence, and Case 6 experienced liver metastasis. Case 5 was documented from postoperative PET-CT. PET-CT, positron emission tomography–computed tomography; SPDP, spleen-preserving distal pancreatectomy.

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  Fig. 3 Images show the sites of local recurrence for ten patients who underwent postoperative CT/PET-CT examinations in our hospital in the DPS group (purple: recurrence, green: metastasis): all cases exhibited central region recurrence. Cases 1 and 2 had spleen region recurrences. Case 9 experienced omental metastases, and Case 10 had liver metastases. Case 8 was documented from postoperative PET-CT. PET-CT, positron emission tomography–computed tomography; DPS, distal pancreatectomy with splenectomy.

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  Fig. 4 Comparisons of overall survival and recurrence-free survival between patients in the SPDP group and the DPS group include: (A) Kaplan-Meier (K-M) curve and number at risk of OS in both groups. (B) K-M curve and number at risk of RFS in both groups. The median follow-up time was 30.2 vs 25.5 months. SPDP, spleen-preserving distal pancreatectomy; DPS, distal pancreatectomy with splenectomy; OS, overall survival; RFS, recurrence-free survival.

Reference

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