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Background: Robotic assisted minimal invasive approach has the potential to overcome the limitations of conventional laparosopic pancreatic resections. We analyzed the outcomes of robotic distal pancreatectomies performed at our institution to demonstrate the safety and feasibility of spleen preservation during distal pancreas resections.
Methods: A retrospective chart review of 40 patients undergoing robotic distal pancreatic resections between 2006 and 2010 was performed. Data was collected for demographics, clinical presentation, perioperative course, histology, and survival. Comparisons were performed between two groups of patients undergoing robotic spleen preserving distal pancreatectomy (SPDP) and distal pancreatectomy with splenectomy (SDP). Survival analysis was performed using the Kaplan-Meier method.
Results: Twelve patients underwent SPDP compared to 28 SDP patients. The two groups were similar in the distribution of their clinical characteristics, including ASA class. There were no significant differences between SPDP and SDP groups in respect to the operative time (181 vs. 210 min, p=0.09), blood loss (151 vs. 174 ml, p=0.95) and perioperative blood transfusions (n=1, 8% vs. n=0, p=0.30). The incidence of postoperative Clavien grade I and II complications (n=4, 33% vs. n=10, 36% p=0.99), Clavien grade III and IV complications (n=2, 17% vs. n=0, p=0.09) and clinically significant pancreatic fistulas (n=0 vs. n=2, 7%, p=0.99) also did not differ between the two groups. There were no perioperative mortalities. There was no significant difference in the incidence of malignancy (n=3, 25% vs. n=10, 36% p=0.71) and median length of hospital stay (4.5 vs. 5 d, p=0.49). One and two year survival rates were also similar in both groups (1 y= 86% vs. 88%, 2 y= 86% vs. 68%, p= 0.34).
Conclusion: Robotic spleen preserving distal pancreatectomy is a safe and feasible surgery with similar perioperative and survival outcomes when compared to distal pancreatectomy with splenic resection.

Perioperative and survival outcomes

	Spleen Preserving Distal Pancreatectomy (SPDP, n=12)	Distal Pancreatectomy with Splenectomy (SDP, n=28)	P-value
Operative time (min)	181	210	0.09
Estimated blood loss (ml)	151	174	0.95
Perioperative blood transfusion	1	0	0.30
Clavien grade I or II complications	4 (33%)	10 (36%)	0.99
Clavien grade III or IV complications	2 (17%)	0	0.09
Clinically significant pancreatic fistula ISGPF (§) grade B or C	0	2 (7%)	0.99
Median length of hospital stay (days)	4.5	5	0.49
1 year survival	86%	88%	0.34
2 year survival	86%	68%

§ ISGPF: International study group definition of postoperative pancreatic fistula.

Histopathology

	Spleen Preserving Distal Pancreatectomy (SPDP, n=12)	Distal Pancreatectomy with Splenectomy (SDP, n=28)	P-value
Pancreatic Carcinoma	3 (25%)	10 (36%)	0.71
Neuroendocrine tumor	4 (33%)	4 (14%)
IPMN	1 (8%)	5 (18%)
Other benign neoplasms	3 (25%)	6 (21%)
Chronic Pancreatitis	0	0