Gutierrez Blanco D, Apodaca-Rueda M, Maeda CT, Carvalho CGCY, Baker E, Martinie JB, Araujo RLC. Indications and techniques for minimally invasive spleen-preserving distal pancreatectomy. World J Gastrointest Surg 2025; 17(10): 109774 [PMID: 41178882 DOI: 10.4240/wjgs.v17.i10.109774]
Corresponding Author of This Article
Raphael L C Araujo, MD, PhD, Adjunct Professor, FACS, Department of Surgery, Universidade Federal de São Paulo, R. Napoleão de Barros, 715, São Paulo 04024-002, São Paulo, Brazil. raphael.l.c.araujo@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Oct 27, 2025; 17(10): 109774 Published online Oct 27, 2025. doi: 10.4240/wjgs.v17.i10.109774
Indications and techniques for minimally invasive spleen-preserving distal pancreatectomy
David Gutierrez Blanco, Marcio Apodaca-Rueda, Carlos T Maeda, Camila G C Y Carvalho, Erin Baker, John B Martinie, Raphael L C Araujo
David Gutierrez Blanco, Erin Baker, John B Martinie, Raphael L C Araujo, Department of Surgery, Hepato-pancreato-biliary Service, Carolinas Medical Center, Atrium Health, Charlotte, NC 28204, United States
Marcio Apodaca-Rueda, Carlos T Maeda, Raphael L C Araujo, Department of Surgery, Universidade Federal de São Paulo, São Paulo 04024-002, São Paulo, Brazil
Camila G C Y Carvalho, Department of Surgical Oncology, Sao Paulo State Employee Hospital, São Paulo 04029-000, São Paulo, Brazil
Author contributions: Gutierrez Blanco D and Araujo RLC performed the research, study design, manuscript preparation; Apodaca-Rueda M, Maeda CT, Carvalho CGCY, Baker E, and Martinie JB contributed to study design, critical revision, and figure generation.
Conflict-of-interest statement: All authors declared no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Raphael L C Araujo, MD, PhD, Adjunct Professor, FACS, Department of Surgery, Universidade Federal de São Paulo, R. Napoleão de Barros, 715, São Paulo 04024-002, São Paulo, Brazil. raphael.l.c.araujo@gmail.com
Received: May 21, 2025 Revised: June 7, 2025 Accepted: August 21, 2025 Published online: October 27, 2025 Processing time: 156 Days and 12.2 Hours
Abstract
Spleen-preserving distal pancreatectomy (SPDP) has gained increasing attention as a safe and effective alternative to distal pancreatectomy with splenectomy, particularly for benign and low-grade malignant lesions of the pancreatic body and tail. This narrative review evaluates the current evidence, technical considerations, and disease-specific indications for SPDP. Literature was reviewed using up to date scientific evidence and most recent national and international guidelines. Studies addressing SPDP outcomes, splenectomy complications, and disease-specific oncologic principles were included. Spleen preservation has been associated with reduced rates of postoperative infections, thromboembolic events, and long-term immunologic compromise, without compromising oncologic outcomes in selected patients. Indications favoring SPDP include pancreatic neuroendocrine tumors, intraductal papillary mucinous neoplasms, and solid pseudopapillary neoplasms. Although current guidelines generally recommend splenectomy for pancreatic ductal adenocarcinoma, emerging data suggest that spleen preservation may be feasible in highly selected cases. Technical approaches—primarily the Kimura and Warshaw techniques—enable safe dissection and splenic vessel management, particularly with the support of minimally invasive platforms. In conclusion, SPDP should be considered in appropriately selected patients to reduce morbidity while preserving long-term immune function. Future randomized studies are warranted to define oncologic safety and refine indications across tumor types.
Core Tip: Splenectomy is usually performed as part of the distal pancreatectomy procedure due to the organs' close anatomic relationship and the inherent difficulty in separating or preserving the splenic blood supply. Nonetheless, the spleen plays an important role in immunological response, and its preservation has been linked to improvements in overall short- and long-term outcomes. As a result, for benign pancreatic lesions splenic preservation is preferable to standard splenectomy. As minimally invasive distal pancreatectomy has risen in popularity, positive long-term outcomes are largely debated.
