Autogenic Splenic Implantation in distal pancreatectomy with Splenectomy for benign lesions of the distal pancreas (RESTORE)

Summary Background: Distal pancreatectomy (DP) for benign and low grade malignant lesions often results in concomitant splenectomy because spleen-preserving distal pancreatectomy (SPDP) is not always technically feasible. Splenectomised patients are at greater risk of developing severe septic complications, such as “overwhelming post-splenectomy infection (OPSI) syndrome. To prevent OPSI, patients require regular vaccinations and a lifelong commitment to prophylactic antibiotics. There is a need for the development of splenic function preservation following DP for benign pancreatic conditions. In the 90’s several authors described a procedure during which multiple fragments of splenic parenchyma were placed in created pouches of the greater omentum: autogenic splenic implant (ASI). ASI has proven to be feasible in patients who underwent posttraumatic splenectomy. For patients undergoing distal pancreatectomy and splenectomy (DPS) for pancreatic lesions the feasibility of ASI is unknown. Materials & Methods: This randomised controlled trial (RESTORE), investigates the feasibility of ASI in patients undergoing DPS for benign and low grade malignant lesions and compares the immunologic splenic function of patients undergoing ASI with patients undergoing DPS and with patients undergoing SPDP. RESTORE will include a total of 45 patients undergoing elective laparoscopic distal pancreatectomy for benign or low grade malignant lesions of the distal pancreas. In 15 patients ASI will be performed, in 15 patients DPS and in 15 patients SPDP Results: This video shows the technical aspects of ASI during laparoscopic DPS for a suspected pseudopapillary tumor of the distal pancreas in a 49-year old female within the RESTORE trial. Conclusions: The RESTORE trial will investigate the feasibility and splenic function after ASI during elective laparoscopic distal pancreatectomy.