Srikanth Gadiyaram, Dr, Yashas H Ramegowda, Dr, Gaurav Singh, Dr. Sahasra Hospitals, Center of Excellence for Gastroenterology
Background: Laparoscopic distal pancreatectomy with (LDPS) or without splenectomy for cystic tumors in the body and tail has become the standard of care. We herein report three patients with giant pancreatic cystic neoplasms (GPCN) who underwent a distal pancreatectomy with splenectomy.
Methods: Records of patients who underwent LDPS for giant cystic tumors (Greater than 5 cm in diameter) by first author (SG) in the last three years were reviewed. All patients received pre-operative pre-splenectomy prophylaxis. LDPS was done using a five port technique. Resected specimens were extracted in an endobag. A tube drain was placed at the completion of the procedure adjacent to the transected border of pancreas.
Results: Three patients, one male (Case 1) and two female (Case2, Case 3) age 69, 25 and 64 years respectively were operated during the study period. The first two patients presented with pain abdomen which led to detection of the cystic tumors on Ultrasound (USG) imaging. Case 3 was asymptomatic and detected on USG during routine health check. MDCT was performed in all patients. The sizes of the tumors were 8, 12 and 9 cm in maximum diameter respectively. All patients had the splenic artery stretched out around the cranial parts of the neoplasm. Splenic vein was stretched and displaced in the first two and thrombosed in the last patient. An endoscopic ultrasound (EUS) was performed in all patients and a preoperative diagnosis of serous cystic neoplasm was made in one and mucinous neoplasm in the other two. All patients underwent LDPS using a five port techique, the pancreas was transected using Endo GIA white cartridge and specimen extraction was done in an endobag by enlarging the umbilical port site, left subcostal incision by joining left midclavicular and anterior axillary ports and in one through a Pfannenstiel incision. All three patients made an uneventful postoperative recovery. Oral intake was started on first postoperative day and surgical drain was removed on postoperative day two in all. Hisopathology showed a serous cystadenoma, solid cystic pseudopapillary tumor and mucinous cystic neoplasm respectively. At a follow-up of 72, 48 and 42 months all patients are asymptomatic.
Conclusion: Laparoscopic distal pancreatectomy is feasible in patients with GPCN and offers the benefits of lesser postoperative pain and early recovery. Splenectomy was required in all patients because of technical reasons viz; gross distorsion of splenic vessels, thrombosis of splenic vein.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93918
Program Number: P446
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster