Long term outcome after minimally invasive and open Warshaw and Kimura techniques for spleen-preserving distal pancreatectomy: International multicenter retrospective study

Salvatore Paiella, Matteo de Pastena, Maarten Korrel, Teresa Lucia Pan, Giovanni Butturini, Chiara Nessi, Riccardo de Robertis, Luca Landoni, Luca Casetti, Alessandro Giardino, Olivier Busch, Antonio Pea, Alessandro Esposito, Marc Besselink, Claudio Bassi, Roberto Salvia

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15 Citations (Scopus)


Background: The Warshaw (WT) and the Kimura (KT) techniques are both used for open or minimally invasive (MI) spleen preserving distal pancreatectomy (SPDP). Multicenter studies on long-term outcome of WT and KT are lacking. Methods: Multicenter retrospective study with transversal follow-up moment, including patients who underwent SPDP from 2000 to 2017 at three high-volume centers in Italy and the Netherlands. Primary endpoint was the incidence of short and long term complications. Patients without regular follow-up were interviewed about symptoms and complications. Results: In total, 164 patients were enrolled, 55 WT (33.5%) and 109 kT (66.5%), of which 95 (57.9%) MI. There was no 30-day mortality (0%).The only significant difference in short-term outcome was more delayed gastric emptying (DGE) after WT (9.1% vs 1.8%, p = 0.043). MI-SPDP was associated with less blood loss (median 150 vs 250 ml, respectively, p < 0.001), less DGE (0% vs 10%, p = 0.002), less abdominal abscesses (8.4% vs 18.4%, p = 0.03) and less splenic infarctions (3.2% vs. 13%, p = 0.042), than open SPDP. Long-term follow-up (median 41 months) was available for 111 patients (67.7%) of whom 18 (16.2%) had an SPDP-related long-term sequela, mostly perigastric varices (n = 11, 9%) but without differences between WT and KT. Less long-term sequelae were reported after MI as compared to open SPDP (12.5% vs 21.2%, p = 0.032). Conclusions: In this international retrospective study, the WT and KT had comparable short- and long-term outcomes. If a KT does not seem feasible during SPDP, a WT is recommended, rather than performing a splenectomy. MI-SPDP was associated with less short- and long term complications as compared to an open SPDP.

Original languageEnglish
Pages (from-to)1668-1673
Number of pages6
JournalEuropean Journal of Surgical Oncology
Issue number9
Publication statusPublished - 1 Sept 2019


  • Minimally invasive pancreatic resection
  • Pancreatic neuroendocrine tumor
  • Pancreatic resection
  • Parenchyma-sparing pancreatic resection
  • Spleen-preserving pancreatectomy

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