Spleen-Preserving Distal Pancreatectomy for Benign or Low-Grade Malignant Tumors

Indications for Spleen Preservation

For benign or low-grade malignant tumors in the distal pancreas, spleen-preserving distal pancreatectomy (SPDP) is the recommended approach when technically feasible, particularly for smaller tumors not involving the splenic vessels, as recommended by the National Comprehensive Cancer Network 1, 2
Spleen preservation should be attempted for insulinomas, which are smaller tumors not involving splenic vessels, ideal candidates for SPDP, according to the National Comprehensive Cancer Network 1, 2
Small peripheral tumors (<2 cm) can undergo distal pancreatectomy with or without splenectomy, as stated by the National Comprehensive Cancer Network 1, 3

The Warshaw Technique (Splenic Vessel Ligation) ligates splenic vessels while preserving short gastric vessels, achieving lymph node retrieval comparable to en bloc splenectomy, as described by the National Comprehensive Cancer Network 1, 2

Splenectomy is mandatory for glucagonomas, which are typically malignant with regional node involvement requiring distal pancreatectomy with splenectomy, as recommended by the National Comprehensive Cancer Network 1, 4
Splenectomy is also required for VIPomas, which require splenectomy with peripancreatic lymph node resection, according to the National Comprehensive Cancer Network 1, 2
Larger tumors (>2 cm) or malignant-appearing lesions require splenectomy when adequate lymph node dissection is needed, as stated by the National Comprehensive Cancer Network 1, 3
Tumors with splenic vessel involvement require splenectomy when vessels cannot be preserved, as recommended by the National Comprehensive Cancer Network 1, 2
For glucagonomas, perioperative anticoagulation should be considered due to hypercoagulable state and increased risk of pulmonary emboli, as suggested by the National Comprehensive Cancer Network and Praxis Medical Insights 1, 4