Work

Three Types of Collateral Arterial Supply to the Spleen After Spleen-Preserving Distal Pancreatectomies with Splenic Vessels Resection—How to Use This Knowledge for Organ(s) Preservation in Locally Advanced and Borderline Resectable Pancreatic Head Cancers Surgery—Hemodynamic, Surgical and Oncological Outcomes of 134 Spleen-Preserving Pancreatectomies

Year: 2026

Type: article

Abstract: Background. Spleen-preserving (SP) distal pancreatectomy (DP) with splenic vessels resection (SVR) (Warsaw procedure, WP) is an option for treatment of tumors with low-malignant potential. The reverse blood flow through the short gastric arteries (SGA) explains the preservation of the spleen after SVR, but leaves the source of blood supply to the SGAs hidden. The types of blood supply to the spleen after WP and their incidence have not been previously described, nor has the significance of these types for locally advanced pancreatic head cancers (LAPHC) surgery. Aim. To determine the main types of the spleen blood supply after WP, and to assess feasibility and safety of splenic artery (SA) rotation for the organ-preserving surgery of LAPHC. Methods. Retrospective analysis of demographic and perioperative data, including CT scans analysis, overall (OS) and progression-free (PFS) survival after 71 SP DP SVR and 41 SP SVR pancreaticoduodenectomies (PD) and total pancreatectomies (TP) for LAPHC (2007-2025). Results: In 134 SP procedures, SA was resected in 115 cases (71DP, 9 TP, 3 central, 32 PD). Indications for surgery were MCN (41), IPMN (14), CSA(3), NEN(25), SPPN(8), PHDAC(40), sarcoma(1), autoimmune(1), and calculous chronic pancreatitis(1). There were no deaths and ischemia-related splenectomies. Morbidity-31%(n23), Dindo-Clavien (D-C)> 3b-2,8%, POPF grade B-n7(10.6%), splenic infarctions on CT after SVR-n18(23%), with one symptomatic. CT revealed three types of arterial blood supply to the spleen after SPDPSVR: left gastric artery(LGA) type (n50,70,5%), gastro-epyploic arcade (GEA) type(n9,12,5%), and an intermediate type(n12,17%). Spleen- and pancreas tail-preserving SVR pancreatectomies for LAPHC (n41) were accompanied by rotation of the SA to substitute resected SMA(n19) and CHA(n15) for 26 Whipples and 8TPs. There were no ischemic complications. D-C >3-19.5%. Median OS and PFS for PDAC was 35 and 21 months for 29.5 months median follow-up. Conclusion. The main collaterals supplying the spleen after WP are LGA branches (~ 90%). This knowledge with strict adherence to the developed criteria safely preserves the spleen, pancreatic tail and stomach during pancreatectomies with SA resection, including its rotation for substitution of the SMA and CHA in LAPHC.

Source: Cancers

DOI: 10.3390/cancers18101675