title: Splenic preserving distal pancreatectomy: does vessel preservation matter?
abstract: BACKGROUND
  Splenic preserving distal pancreatectomy (SPDP) can be accomplished with splenic artery and vein preservation or ligation. However, no data are available on the relative merits of these techniques. The aim of this analysis was to compare the outcomes of splenic preserving distal pancreatectomy with and without splenic vessel preservation.
  
  
  METHODS
  From 2002 through 2009, 434 patients underwent distal pancreatectomy and 86 (20%) had splenic preservation. Vessel preservation (VP) was accomplished in 45 and ligation (VL) was performed in 41. These patients were similar with respect to age, American Society of Anesthesiologists class, pathology, surgeons, and minimally invasive approach (79%). For comparison, a matched group of 86 patients undergoing distal pancreatectomy with splenectomy (DP+S) was analyzed.
  
  
  RESULTS
  The VP-SPDP procedure was associated with less blood loss than VL-SPDP or DP+S (224 vs 508 vs 646 mL, respectively; p < 0.05). The VP-SPDP procedure also resulted in fewer grade B or C pancreatic fistulas (2% vs 12% vs 14%; p = NS) and splenic infarctions (5% vs 39%; p < 0.01), less overall morbidity (18% vs 39% vs 38%, respectively; p < 0.05) and need for drainage procedure (2% vs 15% vs 16%; p < 0.05), and shorter post-operative length of stay (4.5 vs 6.2 vs 6.6 days; p < 0.05).
  
  
  CONCLUSIONS
  This analysis suggests that outcomes are (1) best for VP-SPDP and (2) VL-SPDP provides no short-term advantage over distal pancreatectomy with splenectomy. We conclude that splenic VP is preferred when SPDP is performed.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Joal D
authors.initials: JD
authors.lastname: Beane
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: Attila
authors.initials: A
authors.lastname: Nakeeb
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.forename: Michael G
authors.initials: MG
authors.lastname: House
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Zyromski
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Howard
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010182:Pancreatic Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013156:Splenectomy; D013157:Splenic Artery / Q000601:surgery*; D016896:Treatment Outcome