Laparoscopic Distal Pancreatectomy for Pancreatic Tumors

Ching-Yao Yang, MD, I-Rue Lai, MD PhD, Ming-Tsan Lin, MD PhD, Po-Huang Lee, MD PhD, Yu-Wen Tien, MD PhD. National Taiwan University Hospital

Introduction:
Experience of laparoscopic pancreatectomy for treatment of pancreatic tumors remains limited. The purpose of this study is to evaluate the feasibility, safety, interim outcome of laparoscopic distal pancreatectomy for patients with pancreatic neoplasms at our hospital.
Methods, and Procedures:
The clinical data and follow-up outcome were prospectively recorded in patients undergoing laparoscopic distal pancreatectomy for pancreatic neoplasms from July 2009 to June 2010. The perioperative parameters, morbidity, and follow-up results were analyzed.
Results:
In recent 12 months, we totally performed laparoscopic distal pancreatectomy in 9 patients. The median age is 55.8 years (38-81 years). There were 4 male, and 5 female patients. The mean tumor size is 3.6cm (1.8-4.8cm). Five tumors is cystic neoplasm, and four is solid tumors. All located at pancreatic tail or body. Laparoscopic distal pancreatectomy with splenectomy was performed in 5 cases. Laparoscopic distal pancreatectomy with spleen preservation was attempted in 4 cases, but one case was converted to open procedure due to bleeding. The mean operative time is 191.3 min (120-290 min). Blood loss was all less than 300 cc. Only one case need blood transfusion. The conversion rate is 11.1%. Spleen-preserved successful rate in attempted cases is 75% (3/4).
Three patients experienced ISPGF grade B (2cases) or grade C(1case) pancreatic fistula. Total morbidity rate is about 33% (3/9). Only one case need reoperation, and another patient was treated with pigtail insertion. There’s no mortality. The average hospital stay is 7.77 days (5-12 days).
Conclusion:
According to our experience, laparoscopic distal pancreatectomy applied for treatment of pancreatic tumors is feasible, and safe. The perioperative outcome is similar to the reported results from the leading medical centers in other countries. Due to the limited experience, the advantage when comparing with open procedure need more comparative study in the future.