Spleen-Preserving Distal Pancreatectomy

Concomitant splenectomy has traditionally been performed during conventional distal pancreatectomy because of the anatomic proximity of the pancreas and splenic vessels. Spleen-preserving distal pancreatectomy has been proposed however, subsequent to a more detailed understanding of the function of the spleen and various complications after splenectomy, including severe post-splenectomy infections, thrombocytosis, and increased cancer risk (Di Sabatino et al., The Lancet 378:86–97, 2011; Mellemkjoer et al., Cancer 75:577–583, 1995). Splenic preservation can be performed with splenic vessel preservation (Kimura et al., Surgery 120:885–890, 1996) or Warshaw’s technique (Warshaw, Arch Surg 123:550–553, 1988). Indications, technical methods, and potential pitfalls of spleen-preserving distal pancreatectomy are introduced in this chapter.