Short- and long-term outcomes after minimally invasive spleen-preserving distal pancreatectomy with and without preservation of the splenic vessels: splenic vessel-preserving procedure is a "double-edged sword" in left-sided portal hypertension.

Yusuke Watanabe, Kohei Nakata, Toshiya Abe, Noboru Ideno, Naoki Ikenaga, Masafumi Nakamura

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Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1 citing paper in PubMed.

Robot-Assisted Spleen-Preserving Distal Pancreatectomy for an Epithelial Cyst Arising from an Intrapancreatic Accessory Spleen: A Case Report.Surgical case reports · 2026
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6 authors.

Yusuke WatanabeDepartment of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.

Kohei NakataDepartment of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.

Toshiya AbeDepartment of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.

Noboru IdenoDepartment of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.

Naoki IkenagaDepartment of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.

Masafumi NakamuraDepartment of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan. nakamura.masafumi.861@m.kyushu-u.ac.jp.ORCID http://orcid.org/0000-0003-4293-3610

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSpleen-preserving distal pancreatectomy (SPDP) involves splenic vessel preservation (Kimura procedure) and splenic vessel resection (Warshaw procedure). This study evaluated the short- and long-term outcomes of the minimally invasive (MI) Kimura and Warshaw SPDP.

methodsMedical records of 137 consecutive patients scheduled to undergo MI-SPDP (Kimura group, n = 72; Warshaw group, n = 65) between 2012 and 2024 were retrospectively reviewed.

resultsThe completion rate of the planned procedures was significantly lower in the Kimura group than in the Warshaw group (78% vs. 92%, P = 0.03). However, the patients experienced no major disadvantages due to procedural conversion. Most short-term outcomes were comparable between groups, with the exception of splenic infarction. The prevalence of radiological splenic infarction was significantly lower in the Kimura group than in the Warshaw group (5% vs. 38%, P < 0.01), although the splenic infarctions were clinically harmless. The incidence of perigastric and gastric intramural venous dilatation confirmed on computed tomography during follow-up was significantly lower in the Kimura group than in the Warshaw group (46% vs. 87%, P < 0.01; 21% vs. 39%, P = 0.04, respectively). The postoperative changes in splenic volume were significantly smaller in the Kimura group than in the Warshaw group (median, 17% vs. 28%, P = 0.04). However, 41% of patients in the Kimura group developed postoperative splenic venous stenosis during follow-up, most of whom had left-sided portal hypertension (LSPH), and postoperative splenic volume changes were significantly greater than those in patients who underwent the Warshaw procedure (median, 42% vs. 28%, P = 0.01).

conclusionsIn clinical practice, the short- and long-term outcomes of patients after both procedures were comparable. The Kimura procedure carries the potential risk of postoperative splenic venous stenosis during the follow-up period, which causes LSPH. Establishing the patient selection criteria and suitable surgical procedures to prevent splenic venous stenosis after the MI Kimura procedure is required.

Indexed as

Hypertension, PortalLaparoscopyOrgan Sparing TreatmentsPancreatectomyPancreatic NeoplasmsSpleenSplenic ArterySplenic VeinAdultAgedFemaleHumansMaleMiddle AgedPostoperative ComplicationsRetrospective StudiesKimura procedureLeft-sided portal hypertensionMinimally invasive pancreatectomySpleen-preserving distal pancreatectomyWarshaw procedure

Identifiers

PMID40960541

DOI10.1007/s00464-025-12167-5

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