Spleen-preserving Laparoscopic Extended (subtotal) Distal Pancreatectomy

Chang Moo Kang, Jin Hong Im, Sung Hoon Choi, Ho Kyoung Hwang, Woo Jung Lee. Yonsei University College of Medicine,Seoul, Korea

 

Introduction: Laparoscopic distal pancreatosplenectomy has been regarded as safe and effective treatment option in benign and borderline malignant tumor of the pancreas. With the emphasizing role of spleen increased, spleen-preserving LDP (Sp-LDP) has been widely applied. However, most cases are mainly related to less than 50% left-sided pancreatectomy (division of the pancreas somewhere between body and tail). In cases of tumor locating near the pancreatic neck portion, laparoscopic extended (subtotal) distal pancreatectomy (Sp-ext LDP) should be considered (division of pancreatic neck portion).

Materials and Methods: From January 2006 to June 2011, sixteen patients were attempted for Sp-ext LDP. Patients were divided into two groups according to conserving both splenic vessels (SVC group vs. SVS). Among them, robotic surgical system (da Vinci) was used in two patients.Patients’ characteristics and periopeative surgical outcomes were compared between two groups.

Results: Splenic vessel-conserving Sp-ext LDP (SVC group) was performed in 10 patients and splenic vessels-sacrificing Sp-ext LDP (SVS group) in 6 patients. Eleven patients were female and 5 were male with age, 50.3±15.3 years, and body mass index, 24.4±3.7 Kg/m2. Incidental diagnosis was found in 12 patients. MCN was noted in 5 patients, IPMN in 4, SPT in 3, NET in 2, SCT in 1, and chronic pancreatitis in 1 with resected tumor size, 3.9±3.5 cm. Operation time was 273.3±151.2 min. Estimated amount of intraoperative bleeding was 171.9±175.9ml with only one intraoperative transfusion. Soft diet was started on 1.2±1.0 day, postoperatively, and length of hospital stay was 7.4±2.3 days, postoperatively. There were four clinically relevant postoperative pancreatic fistua (20%), but all could be successfully managed by conservative treatment. There was no spleen-related complication in SVS group, and no mortality was noted. Age, gender, BMI, comorbidities, length of resected pancreas, operative time, intraoperative bleeding, transfusion, postoperative complications, lengths of hospital stay did not significantly different between two groups (p>0.05). All complications could be successfully managed conservatively. No mortality was noted.

Conclusion: Sp-ext LDP is also feasible and safe for benign and borderline malignant disease near the pancreas neck lesion. In selected cases, both splenic vessels also can be safely resected for preserving spleen.

 


Session Number: Poster – Poster Presentations
Program Number: P345
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