Distal resection for pancreatic tumors

Aim. To study the specific features of the splenic artery architectonics and evaluate the results of distal pancreatic resection for various tumors.

Materials and Methods. In the anatomical part, we examined 88 organ complexes taken from people whose death was not associated with diseases of the abdominal organs. We studied the topography of the splenic artery and the dependence of the number of its branches to the pancreas on the vessel tortuosity. The clinical part of the study presents the results of 122 distal resections performed during 2016-2021. 79 operations were carried out using the traditional method, 32 operations were robot-assisted, and 11 were performed laparoscopically.

Results. The research found a relationship between the degree of the splenic artery tortuosity and the number of branches to the pancreas, which varies from three to nine. Out of the 122 operated patients, in 24 (19.7%) cases a clinically relevant (type B) pancreatic fistula that required additional treatment was formed. Intra-abdominal bleeding developed in 15 (12.3%) patients: early – in 10, late arrosive hemorrhage associated with a pancreatic fistula – in 5 cases. One (0.8%) patient died.

Conclusion. It is necessary to consider the architectonics of the splenic artery during distal pancreatic resection. The frequency of pancreatic fistula formation does not depend on the method of performing the operation. Of the prognostic factors, the body mass index is statistically significant. Late arrosive bleeding develops against the background of a clinically relevant pancreatic fistula.

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