The management of pancreatic tail during robotic-assisted spleen-preserving distal pancreatectomy

In robotic spleen-preserving distal pancreatectomy (RSPDP), the relationship between the pancreatic tail and splenic vessels affects whether the distal pancreas can be resected completely or the spleen can be preserved successfully. However, no study has reported surgical strategies for the management of pancreatic tails during RSPDP. In this study, the clinical data of 46 patients who consecutively received robot-assisted distal pancreatectomy (DP) with intended splenic preservation were analyzed. The pancreatic tails were classified into four anatomical variations based on the relationship between splenic vessels and pancreatic parenchyma or tumor. The RDP group had more type IV cases (76.92% vs. 18.18%, P  < 0.05) and less type II cases (7.69% vs. 39.39%, P  < 0.05) compared with the RSPDP group. Compared with the type I/II group, the type III/IV group had a significantly lower spleen-preserving rate (52.17% vs. 91.30%, P  = 0.003). Moreover, the spleen preservation rate was significantly elevated in the second period (2023.01-2024.01, n = 29) than in the first period (2021.01-2022.12, n = 17) (82.76% vs. 52.94%, P  = 0.030). We proposed the preoperative classification of pancreatic tail type and the “pendulum separation” technique, and found that it was challenging to preserve the spleen in type III and IV pancreatic tails due to their complex anatomical relationship with the splenic vessel and tumor.