Minimally Invasive(laparoscopic + Robotic) Spleen-preserving Subtotal Left-sided Pancratectomy

Lim Jin Hong, MD, Whang Ho Kyung, MD, Kim Sung Hoon, MD, Choi Sung Hoon, MD, Lee Woo Jung, MD, Kang Chang Moo, MD. Division of hepatobiliary and pancrreas, department of surgery, Yonsei University College of Medicine

Purpose:
Laparoscopic distal pancreatectomy (LDP) has been regarded as safe and effective treatment option in benign and borderline malignant tumors in left-sided pancreas. With the emphasizing role of spleen increased, spleen-preserving LDP (Sp-LDP) has been widely applied. However, Sp-LDP with division of pancreatic neck (Sp-subtotal LDP) is rarely reported.
Methods :
From January 2006 to June 2011, consecutive 43 patients underwent Sp-LDP for pancreatic benign and borderline malignant tumors. Patients were divided into two groups; Sp- LDP (N=27) vs. Sp-subtotal LDP (N=16). Patients’characteristics and periopeative surgical outcomes were compared between two groups.
Results :
Splenic vessel-conserving Sp-subtotal LDP was performed in 10 patients and splenic vessels-sacrificing Sp-subtotal LDP in 6 patients. Patients’ characteristics (age, sex, BMI, disease type and comorbidities), intraoperative bleeding, lengths of hospital stay, post-op complication did not differ between two group (p>0.05). However, length of resected pancreas was longer in Sp-subtotal LDP group (Sp-LDP : Sp-subtotal LDP = 7.74cm : 10.70cm, p<0.01), and Sp-LDP group required more operative time than Sp-subtotal LDP group (Sp-LDP : Sp-subtotal LDP = 361.96min: 273.31min, p=0.038), but time difference seemed not clinical significant.
Conclusions :
Sp-subtotal LDP is also feasible and safe for benign and borderline malignant disease at the pancreas neck lesion. Both splenic vessels also can be safely resected for spleen preservation in selected cases.
 

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