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Page 4 of 10 Kauffmann et al. Mini-invasive Surg 2020;4:54 I http://dx.doi.org/10.20517/2574-1225.2020.46

Table 1. Baseline characteristics of 54 candidates for RA-SPDP
Study population
Number of patients (%) 54 (100%)
Median age, years (IQR) 60 (46.5-66)
Gender, male (%) 14 (25.9%)
2
Median BMI, kg/m (IQR) 24.1 (21.6-26.3)
Comorbidity (%) 33 (61.1%)
Pre-operative symptoms (%) 20 (37.3%)
Prior abdominal surgery (%) 28 (51.8%)
Median ASA score (IQR) 2 (2-3)
BMI: body mass index; ASA: American Society of Anesthesiologists

Table 2. Intra-operative outcome measures
Result
Median operative time, min (IQR) 260 (231.3-360)
Median estimated blood loss, mL (IQR) 150 (100-150)
Patients receiving blood transfusion, n (%) 4 (7.4%)
Median number of blood units transfused per patient (IQR) 1 (1-1)
Conversion, n (%) 0 (0%)
Pancreatic stump closure: stapled, n (%) 6 (11.1%)
Pancreatic stump closure: oversewn, n (%) 48 (88.9%)

When the splenic vessels could not be preserved, or were injured during dissection, before taking the
decision to proceed with a Warshaw procedure or with splenectomy, resection and reconstruction or repair
were taken into consideration.

Outcome measures
All post-operative events were recorded and classified according to standard outcome metrics [17-19] . Post-
operative pancreatic fistula (POPF) was considered clinically relevant when graded B or C according
to the definition of the international study group (ISGPF) . Complications graded ≥ III in the Dindo-
[17]
[20]
Clavien classification were considered severe . The overall burden of complications was denied using
[21]
the comprehensive complication index . Post-operative mortality was considered as any death occurring
during the first 90 days after surgery or during the initial hospital stay if longer.

RESULTS
During the study period 54 patients were selected for possible RA-SPDP. The baseline characteristics of
these patients are summarized in Table 1.

There was no conversion to open or laparoscopic surgery. The spleen and the splenic vessels were preserved
in 52 of 54 patients scheduled for RA-SPDP (96.3%). In three patients the splenic vessels had to be
reconstructed to avoid a Warshaw procedure or a splenectomy. There were two elective reconstructions,
caused by difficult detachment of the splenic vessels from the tumor, and one urgent reconstruction due
to injury to the splenic vein. Overall, one splenic artery was reconstructed by end-to-end anastomosis and
two splenic veins were reconstructed using an autologous interposition graft. A summary of intraoperative
outcome measures is provided in Table 2.

A summary of the main post-operative outcome measures is provided in Table 3.

Some results are worth to be noted. First, only two patients developed severe post-operative complications.
Both required repeat surgery to address bleeding and splenic infraction, respectively. The first patient was