Single Center Experience of 327 Consecutive Laparoscopic Left Pancreatectic Resection: Changing of Surgical Paradigm of Left Pancreatectic Resection

Songcheol Kim, Ki byung Song, Duck jong Han, Younghun Kim, Jaebum Park, Haeran Ha, Haeryun Seo, Yunbaik Choi. Depetment of surgery, Ulsan University College of Medicine and Asan Medical Center

Aim : Laparoscopic left pancreatic resection (LLPR) is increasingly performed for lesions of the body and tail of the pancreas. The aim of this study is to analyze the clinical characteristics and results after LLPR as a largest single center series , and to find the changing of surgical paradigm of left pancreatic resection

Material and methods: We commenced the laparoscopic pancreatic surgery from May, 2005. 327 patients underwent LLPR for pancreatic neoplasms were reviewed.

Results. The pathologic diagnosis included 68 intraductal papillary mucinous neoplasm (20.8%), 65 mucinous cystic neoplasm (19.9%), 46 serous cystic neoplasm(14.1%), 51 solid pseudopapillary neoplasm(15.6%), 31 neuroendocrine tumors (9.5%), 25 pancreatitis with or without pseudocyst (7.6%), 12 epidermoid cyst, 19 pancreatic ductal adenocarcinoma(5.8%) and 2 pancreatic mucinous adenocarcinoma. 157 cases of spleen saving LLPR was performend(48%), either by main splenic vessel preservation (133, 84.7%) or supported by the short gastric vessels and gastroepiploic vessels (Warshaw technique, 24, 5.3%). The patients with malignant neoplasm of pancreas who were underwent laparoscopic distal pancreatectomy are 31(9.5%). Postoperative complications were occurred in 31(11.9%)patients, including 22 pancreatic fistula(6.7%, ISGPF grade B,C), 10 fluid collection and pseudocyst with drainage(3.1%), 2 post operative bleedings. There was no mortality. Median operative time and postoperative hospital stay were 190 min(range, 78-480 min) and 8 days(range, 4-37days) respectively. The proportion of LLPR was increased from 8.6% in year of 2005( year of commencing the LLPR) to 68% in 2010.

Conclusion. LLPR is becoming as a safe and effective standard surgical method for a wide range of pancreatic neoplasm of body and tail except the far advanced pancreatic cancer.