Robotic distal pancreatectomy using the Warshaw technique demonstrated superior short-term prognosis compared to the laparoscopic approach: propensity-matched cohort study

Background Minimally invasive spleen-preserving distal pancreatectomy (SPDP) presents technical challenges and remains a topic of debate. This study seeks to compare the splenic preservation techniques, especially the Kimura and Warshaw methods, with distal pancreatectomy with splenectomy (DPS) and to examine factors influencing short-term patient prognostic outcomes. Methods A retrospective analysis was undertaken of all consecutive cases of minimally invasive distal pancreatectomy, both with and without spleen preservation, conducted at our center from January 2020 to May 2024. The study assessed the impact of demographic characteristics, operative variables, oncologic pathology review, and postoperative outcomes on patients' prognosis. Propensity score matching (PSM) was conducted at a 1:1 ratio. Both univariate and multivariate analyses were performed to identify risk factors affecting the preservation of the spleen and splenic vessels during distal pancreatectomy. Results The research encompassed data from 490 consecutive patients who underwent minimally invasive distal pancreatectomy. Among the groups with planned spleen-preserving operations, after PSM, the incidence of Clavien-Dindo classification (CDC) >= III (6.3% vs. 0.7%, p = 0.010), postoperative pancreatic hemorrhage (4.2% vs. 0%, p = 0.039) and readmission within 90 days (4.2% vs. 0%, p = 0.039) was significantly higher in the Kimura group. Meanwhile, the Kimura group demonstrated a significantly lower incidence of splenic infarction (6.3% vs. 31.3%, p < 0.01) compared to the Warshaw group. Grouped by the minimally invasive methods, the robotic-SPDP (R-SPDP) group exhibited a lower rate of splenic infarction (7.6% vs. 27.5%, p < 0.01), as well as reduced operative time (145 vs. 175 min, p < 0.01) and postoperative hospital stay (6 vs. 8 days, p < 0.01), compared to the laparoscopic-SPDP (L-SPDP) group. An analysis of the minimally invasive technique revealed that the SPDP group experienced a lower rate of pleural effusion (5.6% vs. 16.8%, p = 0.009) than the DPS group after PSM analysis. Univariate analysis identified tumor diameter, operative time, Warshaw technique, and laparoscopic procedure as prognostic factors for the occurrence of splenic infarction. The Warshaw technique and laparoscopic approach were identified as independent prognostic factors for splenic infarction in multivariate analysis. Conclusions Both techniques have demonstrated efficacy in minimally invasive SPDP. Our findings indicate that the robotic-assisted Warshaw approach may offer enhanced efficiency and safety.