"Extended" Distal Pancreatectomy with Segmental Resection of Both Splenic Vessels; Extended Warshaw's Procedure

Purpose: We would like to assess the safety and feasibility of extended spleen-preserving distal pancreatectomy with segmental resection of both splenic vessels (SPDP-SRSV) in patients with large, benign and borderline malignant pancreas body tumors. Methods: We encountered seven extended SPDP-SRSV cases from January 2006 to March 2010. Among them, three were excluded due to combined pylorus-reserving pancreaticoduodenectomy (PPPD). For the extended surgical technique, the pancreas was divided above the confluence of the superior mesenteric vein-splenic vein-portal vein (SMV-SV-PV), and vascular control was achieved at the origin of the splenic artery and the junction of the splenic vein with the SMV. The segments of both splenic vessels were then extracted along with the specimen. Results: All the patients were female with a median age of 57 years (range: 24~70 years). The median tumor size was 5.5 cm (range: 5~11 cm), the median operation time was 362 minutes (range: 337~441 min), the median estimated blood loss was 150 ml (range: 50~300 ml) and the median hospital stay was 9 days (range: 7~20 days). One patient underwent robot-assisted extended Warshaw procedures. No mortality was noted, but one partial intestinal obstruction occurred and this was resolved with conservative management. On the recent follow-up, the CT scans showed no evidence of tumor recurrence or spleen infarction, but newly developed perigastric varix was noted, but it was without variceal bleeding. Conclusion: SPDP-SRSV with division of the pancreatic neck portion above the confluence of the SMV-SV-PV in patients with large, benign and borderline malignant pancreatic body tumors appears to be an ideal approach because of the expected long-term survival and preserving the role of the spleen.