The Operative Outcome of Lapaloscopic Distal Pancreatectomy

Hiroyuki Katagiri, MD PhD, Kazunori Furuta, MD PhD, Kazunori Nakamura, MD, Mina Waraya, MD, Hiroshi Kawamata, MD, Hiroki Kamata, MD PhD, Kenichiro Ishii, MD PhD, Yusuke Kumamoto, MD PhD, Masahiko Watanabe, MD PhD. Department of Surgery, Kitasato University, School of Medicine

(INTRODUCTION)The laparosopic surgery for pancreatic disease is progressing technically. Also this procedure will bring more benefit for the patients as minimally invasive operation. However the safeness of procedure and target disease for operation have not been provided a general consensus in Japan. The aim of this study is analyzing of operative outcome of distal pancreatectomy for various tumor and to confirm safety of this procedure. (METHODS) We performed a retrospective analysis of patients who underwent laparoscopic distal pancreatectomy from 2004 to 2009 at Kitasato university east hospital in Japan. 24 patients were included in the study with varyingly preoperative diagnosis such as endocrine tumors (7 patients), cystic lesions (8 patients) and IPMN (9 patient). The median age was 54.1 years with female to male ratio of 14:10. Technically, In addition to 3 ports, a hand port was placed in the midline to aid in dissection and the pancreas was divided with a stapler. When we remove pancreas surgically, we spend time more than one minute per single fire to avoid postoperative pancreatic fistula. (RESULTS) Of 24 patients, two were converted to an open procedure due to an uncertain adhesion and inadequate exposure. The median operating time was 213 minutes with a tumor size of 3.8cm. The median time for resuming regular diet and converting to oral pain medications was 2.5 days and 4 days respectively. The length of hospitalization was 11.6 days (5-17). 22 patients who underwent the laparoscopic operation successfully and these were no postoperative complication. With a median follow up of 27.5 months (1-53), 5 patients with a diagnosis of malignancy have no evidence of recurrence until now. (CONCLUSION) A minimally invasive approach to pancreatic disease is safe and technically feasible. Further large series studies with longer follow up are necessary to determine the role of laparoscopic surgery in the treatment algorithm of management of pancreatic disease.