Robot-assisted spleen preserving distal pancreatectomy (RA-SPDP): a single center experience

Aim: To define the outcome of robot-assisted spleen preserving distal pancreatectomy (RA-SPDP) in a highvolume center. Methods: A retrospective analysis of a prospectively maintained database was performed to identify RA-SPDP performed at our Center between April 2008 to October 2017. Results: During the study period, RA-SPDP was attempted in 54 patients. The spleen was preserved, always along with the splenic vessels (Kimura procedure), in 52 patients (96.3%). There were no conversions to open or laparoscopic surgery. Mean operative time was 260 min (231.3-360.0). Grade B post-operative pancreatic fistula (POPF) occurred in 19 patients (35.2%). There were no grade C POPF. Two patients required repeat surgery because of postoperative bleeding and splenic infarction, respectively. There were no post-operative deaths at 90 days. Excluding one patient with known diagnosis of metastasis from renal cell carcinoma, malignancy was eventually identified in 7 of 53 patients (13.2%). Conclusion: In the hands of dedicated pancreatic surgeons, robotic assistance results in a high rate of spleen preservation with good clinical outcomes. Despite careful preoperative selection, several patients can be found to have a malignant tumor. Taken altogether these results suggest that patients requiring these procedures should be preferentially referred to specialized centers.