Surgical approach and postoperative outcomes after left pancreatectomy (Spandispan prospective project)

Abstract

Introduction

Left pancreatectomy (LP) is a surgical technique with low mortality but high morbidity (30%), particularly pancreatic fistula (PF). Its minimally invasive (MI) approach has become popular, but its implementation in Spain remains unknown. We present a national multicentre study on LP to determine morbidity-mortality, PF incidence, and the percentage of MI approach.

Methods

A descriptive, observational, prospective, and multicentre study on LP. Study period: 02/01/2022–02/28/2023. Inclusion criteria: Elective LP. Exclusion criteria: LP following pancreaticoduodenectomy, with celiac trunk resection, or performed as an emergency. Major complications (MC): Clavien–Dindo ≥ IIIA.

Results

A total of 41 centres participated, including 313 patients. Women accounted for 53.4%. Mean age: 63.4 years. The most common indications for LP were neuroendocrine tumours (32.6%), pancreatic adenocarcinoma (28%), and IPMN (15.7%). The surgical approach was laparoscopic (53%), open (30.7%), and robotic (16.3%). The most frequently performed techniques were distal splenopancreatectomy (72.2%) and radical antegrade modular pancreatosplenectomy (RAMPS) (14.4%). Complications occurred in 57.5% of patients, with 21.1% classified as MC. The most frequent was PF (38.3%), with 52.5% of PFs classified as B–C (20.1% of the total). The 90-day mortality rate was 1.6%. The use of a protective sleeve and the absence of drains were associated with the absence of PF in multivariate analysis.

Conclusion

In our series, the MI approach was significantly higher than expected (70%). The MC rate was 21.1%, and mortality was 1.6%, confirming that LP is a procedure with low mortality but high morbidity.