Introduction Laparoscopic left pancreatectomy is progressively becoming the new gold standard procedure for the surgical treatment of left pancreatic disorders. However, as open pancreatic surgery, laparoscopic left pancreatectomy patients may present postoperative complications that could impair outcomes. Our aim was to identify preoperative or intraoperative risk factors for major postoperative complications. Patients and methods This is a retrospective analysis of a prospectively collected database of 115 consecutive patients undergoing laparoscopic left pancreatectomy. Surgical procedures performed were laparoscopic left splenopancreatectomy, left pancreatectomy with splenic vessels preservation and left pancreatectomy without splenic vessels preservation (Warshaw’s technique, LLP-WT). 60-day major postoperative complications were classified according to the Dindo-Clavien classification, reviewed and analyzed. Results Out of the 115 patients, 51 (44.3%) underwent LLSP, 25 (21.8%) LLP-SVP and 39 (33.9%) LLP-WT. Major postoperative complications occurred in 15 (13%) patients. Univariate analysis idenfied LLSP as the most important risk factor for major complications (22% vs. 6%, p=0.024). Multivariate analysis identified LLSP as an independent risk of postoperative major complications (p=0.019, HR (95% CI): 4.617 (1.292-16.497)). Conclusions Although splenectomy during laparoscopic left pancreatectomy is necessary in some cases, spleen must be preserved whenever possible, since splenectomy might be associated with a higher risk of major postoperative complications.
Santiago Sánchez-Cabús, Gabriella Pittau, Maximiliano Gelli, Jean-Philippe Adam, Alexandre Jacquin, Christophe Laurent, Antonio Sa Cunha