Takanori Morikawa, MD, PhD, Masahiro Iseki, MD, PhD, Masaharu Ishida, MD, PhD, Tatsuyuki Takadate, MD, PhD, Kyouhei Ariake, MD, PhD, Kei Kawaguchi, MD, PhD, Kunihiro Masuda, MD, PhD, Takeshi Aoki, MD, PhD, Hideo Ohtsuka, MD, PhD, Masamichi Mizuma, MD, PhD, Shinobu Ohnuma, MD, PhD, Hiroki Hayashi, MD, PhD, Kei Nakagawa, MD, PhD, Fuyuhiko Motoi, MD, PhD, Takashi Kamei, MD, PhD, Takeshi Naitoh, MD, Ph, FACS, Michiaki Unno, MD, PhD. Tohoku University
Introduction: Laparoscopic distal pancreatectomy (LDP) is widely accepted as a standard treatment for the tumors located in the pancreas body or tail, and spleen-preserving distal pancreatectomy was established in benign or low-grade malignancies of the distal pancreas which do not need lymphatic clearance. However, it is still controversial whether or not to preserve spleen in case of LDP for benign or low-grade malignant tumor, because laparoscopic spleen-preserving distal pancreatectomy (LSPDP) has some technical difficulties. In our institution, we have performed LSPDP only for the patients with small neuroendocrine neoplasms based on preoperative imaging for the reason of its low malignancy. The aim of this study is to evaluate the feasibility and safety of LSPDP compared with LDP with splenectomy (LDPS).
Methods and Procedures: From July 2009 to August 2018, we performed 76 LDPs (LSPDP: n = 14, LDPS: n = 62) in our institution. We reviewed clinical records of these patients, and clinicopathological findings, surgical outcomes, and diagnostic accuracy were retrospectively analyzed.
Results: In this cohort, there were 54 females, and the median age was 55.5 years old. Two patients who received LDPS were converted to open surgery due to severe pancreatitis and adhesion around the pancreas. On the other hand, one patient in the LSPDP group was converted to hand-assisted LDPS because of strong inflammation between the pancreas and the splenic vessels. There was no significant difference in their characteristics such as age, sex, body mass index and ASA score, however LSPDP was significantly associated with small-sized tumor and nodular tumor. The operation time of LSPDP was significantly longer than LDPS (p=0.02), meanwhile blood loss of each group was similar (p=0.39). In addition, the length of skin incision in the LSPDP group was significantly smaller than the LDPS group. The rate of complication including pancreatic fistula and postoperative courses had no significant difference between groups.
Conclusion: In selected patients, LSPDP is safe and feasible procedure with smaller incision and similar postoperative outcomes compared with LDPS.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94896
Program Number: P624
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster