Background & Aim:
Distal pancreatectomy (DP) can be performed with or without spleen preservation, yet data directly comparing postoperative immunological outcomes across these techniques remain limited. This study reviewed the literature evaluating the immunological implications of splenectomy, comparing outcomes across various DP techniques. It also reviewed and compared textbook outcomes between the currently accepted DP techniques.
Methods:
A literature review was conducted using Ovid Medline/PubMed, Embase, and the Cochrane Library to identify relevant studies published between 2010 and March 31, 2025. Studies were grouped by surgical technique: spleen-preserving distal pancreatectomy (SPDP) vs. distal pancreatectomy with splenectomy (DPS), and splenic vessel-preserving SPDP (SVP-SPDP) vs. splenic vessel-ligating SPDP (SVL-SPDP). Primary outcome was postoperative immunological function; secondary outcomes included textbook outcomes (operative time, intraoperative blood loss, and postoperative complications).
Results:
Ovid Medline/PubMed and Embase yielded 1289 studies. 310 duplicates were identified resulting in 979 studies proceeding to initial screening of titles and abstracts. This resulted in 97 studies undergoing full text review. 50 studies did not meet the selection criteria and were ultimately excluded. 47 studies then proceeded to data extraction. The Cochrane library was then searched yielding 47 results. Initial screening resulted in 40 of these studies being deemed unsuitable. Full text review of the remaining 7 articles resulted in all articles being excluded as they did not meet selection criteria.
Immunological outcomes, particularly postoperative infectious complications, were inconsistently reported. With regards to textbook outcomes, SPDP demonstrated superior outcomes compared to DPS across nearly all parameters, including shorter operative time, reduced blood loss, and lower complication and readmission rates. Comparison between SVP-SPDP and SVL-SPDP showed mixed results; SVL-SPDP had shorter operative times but higher rates of splenic infarction and formation of gastric varices.
Conclusions:
SPDP demonstrated superior textbook outcomes compared to DPS; however, limited immunological data precluded recommendations regarding immune function. Based on superior textbook outcomes, spleen preservation should be prioritized when feasible although the decision must be individualized based on lesion characteristics and surgical expertise.