EAES Academy

Background : Warshaw technique has gained the favor of some surgeons due to its simplicity. Outcomes and surgical risks after robotic distal pancreatectomy with spleen preservation (RDP-SP) by Warshaw technique and with splenectomy (RDP-S) were compared.
Methods:

All the data for patients undergoing robotic distal pancreatectomy (RDP) were prospectively collected. The incidence and clinical significance of spleen infarction and gastric varices after spleen preservation by robotic Warshaw technique were also evaluated.
Results:

A total of 177 patients were included, including 65 RDP and 122 LDP. Conversion rate was 1.5% in RPD group and 3.6% in LPD, P = 0.653. Spleen-preservation by Warshaw technique was 45.9% in total, with 53.1% in RPD group and 41.7% in LPD, P = 0.157. RDP took less operation time than LDP, with median of 2.7 vs 3.5 hours, P = 0.005. Overall, DP with splenectomy took more operation time than that with spleen-preservation, P < 0.001, but the difference regarding the operation time between spleen-preservation and splenectomy was only significant in LDP group, P = 0.003, not in RDP, P = 0.072. Splenectomy was associated with higher blood loss, as compared with spleen-preservation in both RDP and LDP groups. There was no surgical mortality in both groups, and surgical morbidity was of no significant difference between RDP and LDP. Post-operative pancreatic fistula was 22% for overall patients, with 17 % in RDP, and 24% in LDP, P =0.340. There was also no significant difference regarding PPH, wound infection, chyle leakage, and hospital stay. The hospital cost in RDP was much higher than that in LDP, with median of 13,404 vs 7,765 USD, P < 0.001.
Conclusions:

Both robotic and laparoscopic surgeries work equally well for DP. LDP with spleen-preservation by Warshaw technique whenever possible and feasible for those benign or low malignant, is highly recommended in term of cost and blood loss.