• Maarten Korrel, Sanne Lof, Al SarirehBilalBDepartment of Surgery, Morriston Hospital, Swansea, United Kingdom., Bergthor Björnsson, Ugo Boggi, Giovanni Butturini, Riccardo Casadei, Matteo De Pastena, Alessandro Esposito, Jean Michel Fabre, Giovanni Ferrari, Fadhel Samir Fteriche, Giuseppe Fusai, KoerkampBas GrootBGDepartment of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands., Thilo Hackert, Mathieu D'Hondt, Asif Jah, Tobias Keck, Marco V Marino, I Quintus Molenaar, Patrick Pessaux, Andrea Pietrabissa, Edoardo Rosso, Mushegh Sahakyan, Zahir Soonawalla, Francois Regis Souche, Steve White, Alessandro Zerbi, Safi Dokmak, Bjorn Edwin, HilalMohammad AbuMADepartment of General Surgery, Fondazione Poliambulanza Hospital, Brescia, Italy.Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom., Marc Besselink, and European consortium on Minimally Invasive Pancreatic Surgery (E-MIPS).
• Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
• Ann. Surg. 2023 Jan 1; 277 (1): e119e125e119-e125.

ObjectiveTo compare short-term clinical outcomes after Kimura and Warshaw MIDP.BackgroundSpleen preservation during distal pancreatectomy can be achieved by either preservation (Kimura) or resection (Warshaw) of the splenic vessels. Multicenter studies reporting outcomes of Kimura and Warshaw spleen-preserving MIDP are scarce.MethodsMulticenter retrospective study including consecutive MIDP procedures intended to be spleen-preserving from 29 high-volume centers (≥15 distal pancreatectomies annually) in 8 European countries. Primary outcomes were secondary splenectomy for ischemia and major (Clavien-Dindo grade ≥III) complications. Sensitivity analysis assessed the impact of excluding ("rescue") Warshaw procedures which were performed in centers that typically (>75%) performed Kimura MIDP.ResultsOverall, 1095 patients after MIDP were included with successful splenic preservation in 878 patients (80%), including 634 Kimura and 244 Warshaw procedures. Rates of clinically relevant splenic ischemia (0.6% vs 1.6%, P = 0.127) and major complications (11.5% vs 14.4%, P = 0.308) did not differ significantly between Kimura and Warshaw MIDP, respectively. Mortality rates were higher after Warshaw MIDP (0.0% vs 1.2%, P = 0.023), and decreased in the sensitivity analysis (0.0% vs 0.6%, P = 0.052). Kimura MIDP was associated with longer operative time (202 vs 184 minutes, P = 0.033) and less blood loss (100 vs 150 mL, P < 0.001) as compared to Warshaw MIDP. Unplanned splenectomy was associated with a higher conversion rate (20.7% vs 5.0%, P < 0.001).ConclusionsKimura and Warshaw spleen-preserving MIDP provide equivalent short-term outcomes with low rates of secondary splenectomy and postoperative morbidity. Further analyses of long-term outcomes are needed.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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