title: Distal pancreatectomy with splenic preservation: A short-term outcome analysis of the Warshaw technique.
abstract: BACKGROUND
  Spleen-preserving left pancreatectomy (SPDP) with splenic vessels preservation (SVP) or without (Warshaw technique, WT) has been described with robotic, laparoscopy and open surgery. Nevertheless, significant data on medium- and long-term follow-up are still not available, since data in literature are scarce and the level of evidence is low.
  
  
  METHODS
  In this retrospective study, we describe and compare short and medium term results of spleen-preserving distal pancreatectomy in eight patients.
  
  
  RESULTS
  In WT group the duration and the intraoperative bleeding was superior than SVP group. The incidence of perigastric collateral vessels and presence of submucosal varices evidenced at CT scan was 66% in WT group, while only one case occurred in SVP group.
  
  
  CONCLUSIONS
  The limit of laparoscopic approach is the fact that it needs advanced laparoscopic skills, which might result in intraoperative bleeding and splenectomy. The most of literature considered salvage WT intraoperatively performed in case of classical SVP and not only elective WT. The consequence is that there is no difference in immediate postoperative results (operative time, intraoperative bleeding, hospital stay) that are in favour of SVP because WT is performed only in case of failure in preserving the splenic vessels. In fact when this intervention is performed electively, the procedure time is reduced as well as the intraoperative bleeding.
  
  
  CONCLUSIONS
  WT is safe and feasible, even if there are not definitive evidences that demonstrate it is superior to classic SVP. RCTs are needed to determine advantages and disadvantages of WT compared to the classic SVP.
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: carloboselli@yahoo.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Boselli
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: francescobarberini@hotmail.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Barberini
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: chiaralist@gmail.com.
authors.forename: Chiara
authors.initials: C
authors.lastname: Listorti
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: elisa.ecv@gmail.com.
authors.forename: Elisa
authors.initials: E
authors.lastname: Castellani
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: renzicla@virgilio.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Renzi
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: alessia.cor@libero.it.
authors.forename: Alessia
authors.initials: A
authors.lastname: Corsi
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Terni, Italy. Electronic address: veronicagrassi@hotmail.it.
authors.forename: Veronica
authors.initials: V
authors.lastname: Grassi
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Terni, Italy. Electronic address: albancacurri@gmail.com.
authors.forename: Alban
authors.initials: A
authors.lastname: Cacurri
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Terni, Italy. Electronic address: djdesi85@hotmail.it.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Desiderio
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Terni, Italy. Electronic address: stefano.trastulli@hotmail.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Trastulli
authors.affiliation: Department of Surgical Sciences, Sapienza University of Rome, Italy. Electronic address: albert.santoro@tiscali.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Department of Surgical Sciences, Sapienza University of Rome, Italy. Electronic address: danielepironi@gmail.com.
authors.forename: Daniele
authors.initials: D
authors.lastname: Pironi
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: maria.burattini@unipg.it.
authors.forename: Federica
authors.initials: F
authors.lastname: Burattini
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Terni, Italy. Electronic address: roberto.cirocchi@unipg.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.affiliation: Department of General Surgery, Saint Mary Hospital, University of Perugia, Terni, Italy. Electronic address: nicolaavenia@libero.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: giuseppe.noya@unipg.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Noya
authors.affiliation: Department of Digestive Surgery, St. Maria Hospital, Terni, Italy. Electronic address: amilcareparisi@virgilio.it.
authors.forename: Amilcare
authors.initials: A
authors.lastname: Parisi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013154:Spleen / Q000601:surgery*; D016896:Treatment Outcome
keywords: Distal pancreatectomy; Splenic preservation; Warshaw technique