The Value of Tumor Size to Predict Success of Splenic Vessel Preservation in Robot-Assisted Spleen-Preserving Distal Pancreatectomy

This study was to investigate factors that influence success of splenic vessel preservation (SVP) in robot-assisted spleen-preserving distal pancreatectomy (RA-SPDP). Patients undergoing RA-DP between January 2010 and December 2016 at our institution were retrospectively analyzed. Intention-to-treat (ITT) analysis was employed. Univariable and multivariable analyses were used to evaluate factors influencing splenic preservation. There were 210 patients in total, of whom 188 were scheduled for RA-SPDP. Eventually, 160 patients completed spleen preservation. The accurate SP rate was 85.1%. Among 160 completed RA-SPDP, 125 patients underwent splenic vessel preservation (SVP). In the ITT analysis, the SVP rate was 66.5%. Univariable analysis revealed that tumor component (p = 0.012) and tumor size (p < 0.001) were associated with failure of SVP. Multivariable analysis showed tumor size was an independent risk factor for splenic vessel resection (SVR) (OR = 1.653, 95%CI 1.366–2.000, p < 0.001), and a cut-off value of 4 cm provided optimal prediction of SVR. In conclusion, scheduled RA-SPDP had a high splenic preservation rate and SVP could be predicted using a tumor cut-off size of 4 cm.