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Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1020-1032
Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1020
Distal pancreatectomy with or without radical approach, vascular resections and splenectomy: Easier does not always mean easy
Lapo Bencini, Alessio Minuzzo
Lapo Bencini, Alessio Minuzzo, Oncology and Robotic Surgery, Careggi Main Regional and University Hospital, Florence 50131, Italy
Author contributions: Bencini L and Minuzzo A contributed to literature search and writing.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lapo Bencini, MD, PhD, Consultant Physician-Scientist, Oncology and Robotic Surgery, Careggi Main Regional and University Hospital, 3 Largo Brambilla, Florence 50131, Italy. bencinil@aou-careggi.toscana.it
Received: January 5, 2023
Peer-review started: January 5, 2023
First decision: January 20, 2023
Revised: January 24, 2023
Accepted: April 17, 2023
Article in press: April 17, 2023
Published online: June 27, 2023
Processing time: 160 Days and 18.6 Hours
Abstract

Because distal pancreatectomy (DP) has no reconstructive steps and less frequent vascular involvement, it is thought to be the easier counterpart of pancreaticoduodenectomy. This procedure has a high surgical risk and the overall incidences of perioperative morbidity (mainly pancreatic fistula), and mortality are still high, in addition to the challenges that accompany delayed access to adjuvant therapies (if any) and prolonged impairment of daily activities. Moreover, surgery to remove malignancy of the body or tail of the pancreas is associated with poor long-term oncological outcomes. From this perspective, new surgical approaches, and aggressive techniques, such as radical antegrade modular pancreato-splenectomy and DP with celiac axis resection, could lead to improved survival in those affected by more locally advanced tumors. Conversely, minimally invasive approaches such as laparoscopic and robotic surgeries and the avoidance of routine concomitant splenectomy have been developed to reduce the burden of surgical stress. The purpose of ongoing surgical research has been to achieve significant reductions in perioperative complications, length of hospital stays and the time between surgery and the beginning of adjuvant chemotherapy. Because a dedicated multidisciplinary team is crucial to pancreatic surgery, hospital and surgeon volumes have been confirmed to be associated with better outcomes in patients affected by benign, borderline, and malignant diseases of the pancreas. The purpose of this review is to examine the state of the art in distal pancreatectomies, with a special focus on minimally invasive approaches and oncological-directed techniques. The widespread reproducibility, cost-effectiveness and long-term results of each oncological procedure are also taken into deep consideration.

Keywords: Distal pancreatectomy; Minimally invasive; Splenectomy; Laparoscopic

Core Tip: Laparoscopic or robotic distal pancreatectomy is a good option to cure diseases arising from the pancreatic body/tail. The minimally-invasive approach allows to achieve concomitant splenectomy and arterial resections. However, current Literature is still lacking, and the surgical decision is based mainly on the presence of advanced laparoscopic and da Vinci equipment, controlled by skillful experts. A rigorous attention to the general and oncologic principles should be the maintained.