313 Splenic Vein Preserving Distal Pancreatectomy (SVP-DP): A Novel Hybrid Approach to Spleen Preservation

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Abstract Aim Spleen preserving distal pancreatectomy is established for benign and low-grade malignant pancreatic tumours. The Kimura technique preserves both splenic vessels but is technically demanding, while the simpler Warshaw method (preserving only short gastric vessels) carries higher risk of splenic infarction and gastric varices. We describe a novel approach—splenic vein preserving distal pancreatectomy (SVP-DP)—in which the artery is divided but the vein preserved, aiming to reduce left-sided portal hypertension while maintaining splenic preservation. Method Six patients underwent SVP-DP via open, laparoscopic, or robotic approaches. After confirming hepatic inflow, the splenic artery was divided. The pancreas was transected proximal to the lesion, followed by antegrade dissection of the splenic vein. In robotic cases, indocyanine green angiography confirmed splenic perfusion and retrograde venous flow. Results SVP-DP was performed for pancreatic neuroendocrine tumours (2), serous cystadenoma (2), mucinous cystic neoplasm and intra-ductal papillary mucinous neoplasm (1 each). Median lesion size was 34 mm. Follow-up imaging was available in 6/7 patients (median 6 months). Splenic preservation was achieved in all cases. Two patients developed partial splenic infarction which resolved spontaneously. Both developed splenic vein thrombosis, persisting in one case to later develop peri-splenic varices. One Clavien-Dindo ≥3a complication occurred (reoperation for postoperative haemorrhage from colonic mesentery). Median lymph node yield was 17 (in 3 assessed cases). Conclusions SVP-DP is safe, technically feasible, and achieves high rates of splenic preservation. When the splenic vein remains patent, left-sided portal hypertension may be reduced. Further studies are needed to validate long-term outcomes.

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