Skip to main content
Download PDF

Effect of differences in vascular anatomy on surgical outcomes of left pancreatectomy: a retrospective study

World Journal of Surgical Oncology volume 23, Article number: 36 (2025) Cite this article

Abstract

Background

Minimally invasive left pancreatectomy (MILP) is increasingly performed worldwide, necessitating the need for improved understanding of vascular anatomy during surgery. However, the effect of differences in vascular anatomy on surgical outcomes remains unclear. In this study, we aimed to evaluate the effect of vascular anatomical variations on surgical outcomes and identify factors that influence open and minimally invasive surgery (MIS) outcomes.

Methods

This was a single-center retrospective study involving 123 patients who underwent left pancreatectomy (LP). We analyzed the correlation between vascular anatomical variations, namely, (i) the root of the splenic artery (SpA; types 1 and 2), (ii) the parent artery of the dorsal pancreatic artery, (iii) confluence patterns of the left gastric vein, and (iv) the inferior mesenteric vein, and surgical outcomes. We also performed a risk analysis of prolonged operation time, considering surgery-related factors.

Results

SpA type 2 was only significantly associated with longer operation time (p < 0.01) in LP procedures. In all LP cases, the pancreatic resection line (above the portal vein: odds ratio [OR] 3.47; 95% confidence interval [CI] 1.69–11.18; p < 0.01), the SpA type (type 2; OR 2.77; 95% CI 1.16–6.94; p = 0.02), and surgery type (MIS; OR 5.24; 95% CI 2.17–14.00; p < 0.001) were independently associated with prolonged operation times. In open-LP cases, high body mass index (> 24 kg/m2; OR 7.24; 95% CI 1.89–36.34; p < 0.01), tumor location (pancreatic body; OR 6.89; 95% CI 1.79–33.79; p < 0.01), and the SpA type (type 2; OR 5.86; 95% CI 1.72–24.65; p < 0.01) showed significant association with prolonged operations. In MILP cases, sex (male; OR 9.07; 95% CI 2.61–38.65; p < 0.001) and the pancreatic resection line (above the portal vein; OR 4.12; 95% CI 1.18–17.08; p = 0.03) showed significant associations.

Conclusions

SpA type 2 may negatively affect surgical outcomes. Therefore, it is important to recognize and approach vascular anatomy appropriately. MIS, especially robotic surgery, may be effective in mitigating the negative effects of variations in vascular anatomy.

Background

Left pancreatectomy (LP) is a major surgical procedure used to treat pancreatic disease. Although this procedure has the same scope with pancreaticoduodenectomy (PD), it has some differences. Unlike PD, LP does not require complex reconstruction, making it more suitable for minimally invasive surgery (MIS). Consequently, MIS has a shorter performance time and shorter learning curve, hence its widespread acceptance as a standard procedure by hepato-biliary-pancreatic (HBP) surgeons [1,2,3,4,5,6]. However, LP remains a complex procedure because of various potential anatomical difficulties in the left pancreas and its surrounding structures. As minimally invasive-LP (MILP) is now accepted globally, a better understanding of vascular anatomy is crucial to perform safe surgeries [7]. Nevertheless, there are only few studies on the relationship between anatomical variations and surgical outcomes, thus resulting in unclear effects of differences in vascular anatomy on surgical outcomes [8]. Therefore, in this study, we aimed to evaluate the effect of vascular anatomical variations on surgical outcomes and identify surgical factors that negatively influence outcomes in open-LP (OLP) and MILP to examine the efficacy of MIS in LP.

Methods

Study design, aim, and setting

This was a single-center retrospective study. Here, we aimed to evaluate the effect of vascular anatomical variations on surgical outcomes and identify surgical factors that negatively influence outcomes in OLP and MILP to examine the efficacy of MIS in LP. This retrospective study included patients who underwent LP for pancreatic disease at the Department of Gastroenterological Surgery, Gifu University Hospital, between January 2010 and July 2024. All procedures were performed by expert surgeons certified by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. This study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Gifu University (approval number: 2024–102).

Type of surgery

We introduced the laparoscopic surgery for LP in 2012. In accordance with insurance coverage, we first performed the procedure for benign or low-grade malignant tumors. Subsequently, the indication of the laparoscopic surgery in LP was expanded to malignant tumors in 2016. From 2023, regardless of type of disease, all LP surgeries except for cases that required multi-organ resection were performed using robotic-assisted surgery (da Vinci Xi robotic system, Intuitive Surgical, Sunnyvale, CA, USA).

Vascular anatomical variations in LP

We investigated the following vascular anatomical variations by evaluating preoperative contrast-enhanced multi-detector row computed tomography (MDCT) images: (i) the root of the splenic artery (SpA) (type 1: the root of the SpA was positioned upward and not covered by the pancreatic parenchyma; type 2: the root of the SpA was covered ventrally by the pancreatic parenchyma) (Fig. 1), (ii) the parent artery of the dorsal pancreatic artery (DPA), (iii) the confluence patterns of the left gastric vein (LGV), and (iv) the confluence pattern of the inferior mesenteric vein (IMV).

Fig. 1
figure 1

Two types of the SpA root evaluating preoperative contrast-enhanced MDCT images. a SpA type 1: the root of the SpA is positioned upward and not covered by the pancreatic parenchyma. b SpA type 2: the root of the SpA is covered ventrally by the pancreatic parenchyma. MDCT, multi-detector row computed tomography; CHA, common hepatic artery; GDA, gastric duodenal artery; LGA, left gastric artery; SpA, splenic artery

Full size image

Statistical analysis

Fisher’s exact test was used to compare categorical variables between groups. For continuous variables, the Mann–Whitney U test and Kruskal–Wallis test were used to compare differences between independent groups. To evaluate risk factors for prolonged operation time, the patients were classified into two groups based on the median operation time. Variables with a p value < 0.05 in the univariate analysis were included in the multivariate logistic regression model. Statistical significance was set at a two-sided p value < 0.05. All statistical analyses were performed using JMP software (SAS Institute Inc., Cary, NC, USA).

Results

Patients

Overall, 167 patients who underwent LP for pancreatic disease were included. We excluded 44 patients who underwent simultaneous resection of other organs, resulting in a final cohort of 123 patients. Of these, 68 (55.3%) underwent OLP, and 55 (44.7%) underwent MILP (Fig. 2), which included 37 laparoscopic cases and 18 robotic cases.

Fig. 2
figure 2

Exclusion criteria

Full size image

Correlation between surgical outcomes and anatomical variations by surgical procedure of LP

Table 1 shows the summary of the frequency of each vascular anatomical variation observed on preoperative MDCT images and the correlation between these anatomical variations and surgical outcomes (operation time, intraoperative blood loss, and clinically relevant postoperative pancreatic fistula [CR-POPF]) stratified by the surgical procedure of LP.

Table 1 Correlation between surgical outcomes and anatomical variations by surgical procedure of LP
Full size table

The SpA was identified in all 123 patients. Regarding the root of the SpA, type 1 was more common in 59.3% (73/123) of patients, while type 2 was present in the remaining 40.7% (50/123 patients). The DPA was identified in 92.7% of patients (114/123 patients). Regarding the parent artery of the DPA, the superior mesenteric artery was the most common and was present in 34.1% (42/123 patients), followed by the SpA in 26.0% (32/123 patients), the common hepatic artery in 17.9% (22/123 patients), and the celiac artery in 14.6% (18/123 patients). The LGV was identified in 94.3% (116/123 patients). Among the confluence patterns of the LGV, the portal vein was observed in 55.3% (68/123 patients) and the splenic vein (SpV) in 39.0% (48/123 patients). The IMV was identified in 99.2% (122/123 patients). Regarding the confluence patterns of the IMV, the superior mesenteric vein was noted in 55.3% (68/123 patients), and the SpV was observed in 43.9% (54/123 patients).

The type of SpA root showed a significant correlation with surgical outcomes in all LP cases. Type 2 was significantly associated with longer operation time (p < 0.01) and showed a significant trend toward greater intraoperative blood loss (p = 0.06). Interestingly, a more significant correlation between anatomical variation and surgical outcomes was observed in the OLP group, and no significant difference was noted in the MILP group. With regard to CR-POPF, no significant correlation with vascular anatomical variation was demonstrated in any of types of surgery.

Univariate and multivariate analyses of risk factors for prolonged operation time in all LP cases

Table 2 shows the results of univariate and multivariate analyses of the risk factors for prolonged operation time in all LP cases (median operation time: 276 [228–337] min). The univariate analysis identified significant associations between prolonged operation time and the pancreatic resection line, root of the SpA pattern, and type of surgery (all p < 0.01). Multivariate logistic regression analysis revealed that the pancreatic resection line (above the portal vein: odds ratio [OR] 3.47; 95% confidence interval [CI] 1.69–11.18; p < 0.01), the root of the SpA pattern (type 2; OR 2.77; 95% CI 1.16–6.94; p = 0.02), and type of surgery (MIS; OR 5.24; 95% CI 2.17–14.00; p < 0.001) were independently associated with prolonged operation times in all LP cases.

Table 2 Univariate and multivariate analysis of risk factors for long operation time in all LP cases
Full size table

Comparison of patient characteristics between the OLP and MILP groups

The findings of the comparison of patient characteristics between the OLP and MILP groups are shown in Supplemental Table 1. Compared to the MILP group, the OLP group had a significantly higher proportion of patients with cancer (58.8% vs. 34.5%, p = 0.01), pancreatic body tumors (67.6% vs. 36.4%, p < 0.001), and cases of pancreatic resections involving the area above the portal vein (69.1% vs. 50.9%, p = 0.04). On the other hand, the MILP group had a significantly higher proportion of cases with spleen preservation (25.5% vs. 8.8%, p = 0.01) and soft pancreas (70.9% vs. 44.1%, p < 0.001).

Regarding surgical outcomes, the MILP group experienced a significantly longer median operative time (294 min vs. 255 min, p < 0.01), but had less median intraoperative blood loss (10 ml vs. 300 ml, p < 0.001), a lower incidence of clinically relevant postoperative pancreatic fistula (9.1% vs. 26.5%, p = 0.02), and a shorter median postoperative hospital stay (13 days vs. 14 days, p = 0.03) than the OLP group.

Univariate and multivariate analyses of risk factors for prolonged operation time in OLP cases

Table 3 shows the results of univariate and multivariate analyses of risk factors for prolonged operation time in OLP cases. In the univariate analysis, prolonged operation time in OLP cases was significantly associated with body mass index (BMI) (p < 0.01), tumor location (p = 0.04), and the root of the SpA pattern (p = 0.02). Multivariate logistic regression analysis revealed that high BMI (> 24; OR 7.24; 95% CI 1.89–36.34; p < 0.01), tumor location (pancreatic body; OR 6.89; 95% CI 1.79–33.79; p < 0.01), and the root of the SpA pattern (type 2; OR 5.86; 95% CI 1.72–24.65; p < 0.01) were independently associated with prolonged operation times in OLP cases.

Table 3 Univariate and multivariate analysis of risk factors for long operation time in OLP cases
Full size table

Univariate and multivariate analyses of risk factors for prolonged operation time in MILP cases

Table 4 presents the results of univariate and multivariate analyses of risk factors for prolonged operation time in patients with MILP. In the univariate analysis, prolonged operation time in MILP cases was significantly associated with sex (p < 0.001) and the pancreatic resection line (p = 0.04). Multivariate logistic regression analysis revealed that sex (male; OR 9.07; 95% CI 2.61–38.65; p < 0.001) and the pancreatic resection line (above the portal vein; OR 4.12; 95% CI 1.18–17.08; p = 0.03) were independently associated with prolonged operation times in MILP cases.

Table 4 Univariate and multivariate analysis of risk factors for long operation time in MILP cases
Full size table

Discussion

In recent years, MIS has emerged as a standard approach in gastroenterological surgery, a trend that is also observed in the complex and challenging HBP procedure. This is particularly true for LP, as the surgical procedures are relatively easy to standardize. The first laparoscopic-LP (LLP) and robot-assisted-LP (RLP) were performed by Gagner et al. [9] in 1996 and Giulianotti et al. [10] in 2003, respectively. Since then, MILP, which is a combination of both procedures, has become widespread. Given this expansion, the demand for a comprehensive understanding of surgical anatomy has also grown to ensure safe and accurate procedures. To address this, the “Precision Anatomy for Minimally Invasive Hepato-Billiary-Pancreatic surgery (PAM-HBP surgery) Expert Consensus Meeting,” held in Tokyo in 2021 with the participation of international HBP surgeons, aimed at developing recommendations on the anatomical landmarks essential for safe MIS. In preparation for this meeting, Nishino et al. [7] conducted a systematic review to evaluate the available literature on “precision anatomy for MILP,” with a focus on patterns and validations of peripancreatic vascular structures that could serve as key anatomical landmarks for performing MILP safely. Although there have been previous reports on the impact of perioperative factors (such as BMI, visceral fat, malignant disease, multi-organ resection, past abdominal surgery, pancreatic resection line, and surgeon' experience) on surgical outcomes [11,12,13,14,15,16], only few studies have evaluated the effects of vascular anatomy on surgical outcomes following LP [8, 17]. Therefore, in this study, we evaluated the impact of vascular anatomy variations in LP on surgical outcomes. The results showed that only the type of root of the SpA was significantly correlated with operative time and intraoperative blood loss in relation to the variations in peripancreatic vascular structures. Furthermore, this is the first study to discover that this correlation was stronger in the open surgery group than in the MIS group.

In this study, we investigated the frequency of typical vascular anatomical variations directly related to surgical procedures in LP, such as (i) the root of the SpA, (ii) parent artery of the DPA, (iii) confluence patterns of the LGV, and (iv) confluence patterns of the IMV. The results were consistent with those from a systematic review by PAM-HBP surgery [7]. Previous studies reported that SpA type 2 was observed in 33.3%–62.0% of the cases [7, 8, 17,18,19]. In a multivariate analysis, Ishikawa et al. [8] reported that SpA type 2 was an independent risk factor for longer operative times and was associated with increased intraoperative blood loss in 34 LP cases. Nakata et al. [17] also reported that SpA type 2 was associated with a significantly longer median operative time than type 1 (285.0 min vs. 235.5 min, p < 0.01) in 50 LP cases. We had similar findings in our study; this implies that the increased difficulty in isolating the SpA might have been due to this anatomical variation, contributing to longer operative times. We hypothesized that the DPA (especially the type that originated from the SpA), the LGV, and the IMV (especially the type of confluence into the SpV) would affect surgical outcomes as well as the SpA. However, only the confluence pattern of the IMV showed a significant correlation with operative time in all LP cases. Although these vascular anatomical variations did not show significant differences singularly in this study, it is possible that a combination of vascular anatomical variations may have an impact on surgical outcomes.

In this study, we found that the negative impact of anatomical variation in the SpA on surgical outcomes was more pronounced in the open surgery group. We speculate that this is because, during open surgery, the root of the SpA can only be accessed from the ventral direction. Meanwhile, in MIS, the SpA can be approached from both the ventral and craniocaudal direction when viewing magnified high-definition laparoscopic images, making its isolation easier.

Previous studies have suggested that variations in the relationship between the SpA and the pancreatic parenchyma should ideally be used to guide the surgical approach during MILP for safety reasons [5, 8, 20,21,22,23,24,25]. However, SpA isolation is still considered a difficult procedure in LLP because the forceps can only be manipulated in a linear fashion. A previous report on LLP inferred that based on the time required for SpA isolation, compared to type 1, the type 2 variation might be more difficult to isolate (27.0 min vs. 7.0 min, p < 0.001) [17]. In contrast, robotic surgery, which allows free and precise forceps manipulation, may be easier to successfully perform than LLP, with the surgical approach being adjusted according to each anatomical variation. Based on their experience with 20 RLP cases, Takagi et al. proposed selecting a surgical approach tailored to the anatomical pattern of the SpA to enhance procedural safety [18]. With SpA type 1, the root of the artery can be isolated using an anterior approach, with ligation performed first (SpA-first ligation technique). The pancreas is then divided, followed by the division of the SpA and SpV. However, with SpA type 2, the pancreas is divided first (pancreas-first division technique), which facilitates better access to the splenic vessels. We adopted these same strategies for RLP, which may explain why the SpA pattern was not a risk factor for prolonged operative time in MILP in this study. This study is the first to demonstrate that MIS, especially RLP, may have the potential to mitigate the negative impact of anatomical variations of the splenic vessels during LP.

This study has some limitations. This was a single-center retrospective study with a small sample size, which may have introduced selection bias and issues related to statistical multiplicity. Additionally, the proportion of cancer cases was higher in the OLP group. One reason for this is that LLP for benign diseases and low-grade tumors has been covered by insurance in Japan since 2012, while LLP for malignant tumors became covered by insurance in 2016. On the other hand, RLP had already been covered by insurance for surgery for malignant tumors since its introduction. Thus, the percentage of cancer cases in the RLP group was comparable to that in the OLP group. These limitations should be considered when interpreting the study’s results. To achieve more reliable results, a prospective multicenter study with a larger number of patients is necessary.

Conclusions

SpA type 2 may negatively affect surgical outcomes. Therefore, preoperatively recognizing and appropriately approaching vascular anatomy are crucial. MIS allows for adaptable surgical strategies based on individual cases and may be an effective approach to mitigate the negative impact associated with anatomical variations.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

MILP:

Minimally invasive left pancreatectomy

MIS:

Minimally invasive surgery

CR-POPF:

Clinically relevant postoperative pancreatic fistula

SpA:

Splenic artery

DPA:

Dorsal pancreatic artery

LGV:

Left gastric vein

IMV:

Inferior mesenteric vein

OR:

Odds ratio

CI:

Confidence interval

ODP:

Open-DP

BMI:

Body mass index

MDCT:

Multi-detector row computed tomography

HBP:

Hepato-biliary-pancreatic

PAM-HBP:

Precision anatomy for minimally invasive-HBP

SpV:

Splenic vein

LLP:

Laparoscopic left pancreatectomy

RLP:

Robotic left pancreatectomy

OLP:

Open-LP

LP:

Left pancreatectomy

References

  1. Nakamura M, Wakabayashi G, Miyasaka Y, Tanaka M, Morikawa T, Unno M, et al. Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score-matching. J Hepatobiliary Pancreat Sci. 2015;22:731–6. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/jhbp.268.

    Article  PubMed  Google Scholar 

  2. Ohtsuka T, Nagakawa Y, Toyama H, Takeda Y, Maeda A, Kumamoto Y, et al. A multicenter prospective registration study on laparoscopic pancreatectomy in Japan: report on the assessment of 1,429 patients. J Hepato-Bil Pancreat Sci. 2020;27:47–55. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/jhbp.695.

    Article  Google Scholar 

  3. Ohtsuka T, Takahata S, Takanami H, Ueda J, Mizumoto K, Shimizu S, et al. Laparoscopic surgery is applicable for larger mucinous cystic neoplasms of the pancreas. J Hepatobiliary Pancreat Sci. 2014;21:343–8. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/jhbp.32.

    Article  PubMed  Google Scholar 

  4. Sulpice L, Farges O, Goutte N, Bendersky N, Dokmak S, Sauvanet A, et al. Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: time for a randomized controlled trial? Results of an all-inclusive national observational study. Ann Surg. 2015;262:868-73;discussion 873-4. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/SLA.0000000000001479.

    Article  PubMed  Google Scholar 

  5. Matsumoto I, Kamei K, Satoi S, Murase T, Matsumoto M, Kawaguchi K, et al. Laparoscopic versus open distal pancreatectomy for benign and low-grade malignant lesions of the pancreas: a single-center comparative study. Surg Today. 2019;49:394–400. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00595-018-1743-7.

    Article  PubMed  Google Scholar 

  6. van Hilst J, de Rooij T, Klompmaker S, Rawashdeh M, Aleotti F, Al-Sarireh B, et al. Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a Pan-European propensity score matched study [diploma]. Ann Surg. 2019;269:10–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/SLA.0000000000002561.

    Article  PubMed  Google Scholar 

  7. Nishino H, Zimmitti G, Ohtsuka T, Abu Hilal M, Goh BKP, Kooby DA, et al. Precision vascular anatomy for minimally invasive distal pancreatectomy: a systematic review. J Hepatobiliary Pancreat Sci. 2022;29:136–50. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/jhbp.903.

    Article  PubMed  Google Scholar 

  8. Ishikawa Y, Ban D, Watanabe S, Akahoshi K, Ono H, Mitsunori Y, et al. Splenic artery as a simple landmark indicating difficulty during laparoscopic distal pancreatectomy. Asian J Endosc Surg. 2019;12:81–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/ases.12485.

    Article  PubMed  Google Scholar 

  9. Gagner M, Pomp A, Herrera MF. Early experience with laparoscopic resections of islet cell tumors. Surgery. 1996;120:1051–4. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/s0039-6060(96)80054-7.

    Article  CAS  PubMed  Google Scholar 

  10. Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, et al. Robotics in general surgery: personal experience in a large community hospital. Arch Surg. 2003;138:777–84. https://doiorg.publicaciones.saludcastillayleon.es/10.1001/archsurg.138.7.777.

    Article  PubMed  Google Scholar 

  11. van Bodegraven EA, van Ramshorst TME, Bratlie SO, Kokkola A, Sparrelid E, Björnsson B, et al. Minimally invasive robot-assisted and laparoscopic distal pancreatectomy in a pan-European registry a retrospective cohort study. Int J Surg. 2024;110:3554–61.

    PubMed  PubMed Central  Google Scholar 

  12. Balduzzi A, van der Heijde N, Alseidi A, Dokmak S, Kendrick ML, Polanco PM, et al. Risk factors and outcomes of conversion in minimally invasive distal pancreatectomy: a systematic review. Langenbecks Arch Surg. 2021;406:597–605.

    Article  CAS  PubMed  Google Scholar 

  13. Lee SY, Allen PJ, Sadot E, D’Angelica MI, DeMatteo RP, Fong Y, et al. Distal pancreatectomy: a single institution’s experience in open, laparoscopic, and robotic approaches. J Am Coll Surg. 2015;220:18–27.

    Article  PubMed  Google Scholar 

  14. Nassour I, Wang SC, Porembka MR, Augustine MM, Yopp AC, Mansour JC, et al. Conversion of minimally invasive distal pancreatectomy: predictors and outcomes. Ann Surg Oncol. 2017;24:3725–31.

    Article  PubMed  Google Scholar 

  15. Hua Y, Javed AA, Burkhart RA, Makary MA, Weiss MJ, Wolfgang CL, et al. Preoperative risk factors for conversion and learning curve of minimally invasive distal pancreatectomy. Surgery. 2017;162:1040–7.

    Article  PubMed  Google Scholar 

  16. Casadei R, Ricci C, Pacilio CA, Ingaldi C, Taffurelli G, Minni F. Laparoscopic distal pancreatectomy: which factors are related to open conversion? Lessons learned from 68 consecutive procedures in a high-volume pancreatic center. Surg Endosc. 2018;32:3839–45.

    Article  PubMed  Google Scholar 

  17. Nakata K, Ohtsuka T, Miyasaka Y, Watanabe Y, Ideno N, Mori Y, et al. Evaluation of relationship between splenic artery and pancreatic parenchyma using three-dimensional computed tomography for laparoscopic distal pancreatectomy. Langenbecks Arch Surg. 2021;406:1885–92. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00423-021-02101-3.

    Article  PubMed  Google Scholar 

  18. Takagi K, Kumano K, Umeda Y, Yoshida R, Fuji T, Yasui K, et al. Surgical strategies to approaching the splenic artery in robotic distal pancreatectomy. Anticancer Res. 2022;42:4471–6. https://doiorg.publicaciones.saludcastillayleon.es/10.21873/anticanres.15947.

    Article  PubMed  Google Scholar 

  19. Inoko K, Ebihara Y, Sakamoto K, Miyamoto N, Kurashima Y, Tamoto E, et al. Strategic approach to the splenic artery in laparoscopic spleen-preserving distal pancreatectomy. Surg Laparosc Endosc Percutan Tech. 2015;25:e122–5. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/SLE.0000000000000182.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Asbun HJ, Van Hilst J, Tsamalaidze L, Kawaguchi Y, Sanford D, Pereira L, et al. Technique and audited outcomes of laparoscopic distal pancreatectomy combining the clockwise approach, progressive stepwise compression technique, and staple line reinforcement. Surg Endosc. 2020;34:231–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00464-019-06757-3.

    Article  PubMed  Google Scholar 

  21. Takaori K, Uemoto S. Artery-first distal pancreatectomy. Dig Surg. 2016;33:314–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1159/000445016.

    Article  PubMed  Google Scholar 

  22. Asbun HJ, Stauffer JA. Laparoscopic approach to distal and subtotal pancreatectomy: a clockwise technique. Surg Endosc. 2011;25:2643–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00464-011-1618-0.

    Article  PubMed  Google Scholar 

  23. Abu Hilal M, Takhar AS. Laparoscopic left pancreatectomy: current concepts. Pancreatology. 2013;13:443–8. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.pan.2013.04.196.

    Article  PubMed  Google Scholar 

  24. Abu Hilal M, Richardson JR, de Rooij T, Dimovska E, Al-Saati H, Besselink MG. Laparoscopic radical ‘no-touch’ left pancreatosplenectomy for pancreatic ductal adenocarcinoma: technique and results. Surg Endosc. 2016;30:3830–8. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00464-015-4685-9.

    Article  CAS  PubMed  Google Scholar 

  25. Morikawa T, Ishida M, Takadate T, Hata T, Iseki M, Kawaguchi K, et al. The superior approach with the stomach roll-up technique improves intraoperative outcomes and facilitates learning laparoscopic distal pancreatectomy: a comparative study between the superior and inferior approach. Surg Today. 2020;50:153–62. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00595-019-01855-0.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the medical staff of the Department of Gastroenterological Surgery at Gifu University Hospital for their participation in this study. The completion of this study would not have been possible without their diligence and support. We would also like to thank Editage (www.editage.jp) for the English language editing.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan

    Masahiro Fukada, Noriki Mitsui, Takeshi Horaguchi, Yuji Hatanaka, Itaru Yasufuku, Yuta Sato, Jesse Yu Tajima, Shigeru Kiyama, Yoshihiro Tanaka, Katsutoshi Murase & Nobuhisa Matsuhashi

Authors
  1. Masahiro Fukada
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Noriki Mitsui
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Takeshi Horaguchi
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Yuji Hatanaka
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Itaru Yasufuku
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Yuta Sato
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Jesse Yu Tajima
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Shigeru Kiyama
    View author publications

    You can also search for this author inPubMed Google Scholar

  9. Yoshihiro Tanaka
    View author publications

    You can also search for this author inPubMed Google Scholar

  10. Katsutoshi Murase
    View author publications

    You can also search for this author inPubMed Google Scholar

  11. Nobuhisa Matsuhashi
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

Masahiro Fukada conceived the study concept, planned the study design as the principal investigator, interpreted the results, and drafted the manuscript. Nobuhisa Matsuhashi revised the manuscript by adding intellectual content and providing critical advice. Masahiro Fukada, Noriki Mitsui, Takeshi Horaguchi, Yuji Hatanaka, Itaru Yasufuku, Yuta Sato, Jesse Yu Tajima, Sigeru Kiyama, Yoshihiro Tanaka, Katsutoshi Murase, and Nobuhisa Matsuhashi obtained the data, provided critical comments to improve the manuscript, and approved the final submission of this manuscript.

Corresponding author

Correspondence to Nobuhisa Matsuhashi.

Ethics declarations

Ethics approval and consent to participate

This study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Gifu University (approval number: 2024–102). Given the retrospective nature of this study and the exclusion of any potentially identifiable patient data, the requirement for informed consent was waived by the Ethics Committee of Gifu University.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fukada, M., Mitsui, N., Horaguchi, T. et al. Effect of differences in vascular anatomy on surgical outcomes of left pancreatectomy: a retrospective study. World J Surg Onc 23, 36 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12957-025-03700-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12957-025-03700-w

Keywords

World Journal of Surgical Oncology

ISSN: 1477-7819

Contact us