Fate of Small Remnant Pancreas Tail in Splenic Hilum after Laparoscopic Spleen Preserving Distal Pancreatectomy

Abstract

Introduction: Laparoscopic spleen preserving distal pancreatectomy (LSPDP) has been shown to be safe and readily feasible. However, we sometimes encounter anatomically challenging patients with the pancreas tail deep into the splenic hilum. The purpose of this study was to discuss the experience of the surgical technique leaving a deep pancreas tail of the splenic hilum in these patients. Methods: There were ten patients who underwent LSPDP with remnant pancreas tail between November 2019 and July 2021 at Samsung Medical Center, Seoul, Korea. Their short-term postoperative outcomes were analyzed retrospectively. Results: Mean operative time was 180.7 ± 18.9 min, estimated blood loss was 192.9 ± 105.8 ml, and postoperative length of stay was 6.3 ± 1.0 days. All ten lesions were in the body or tail of the pancreas and included: 4 intraductal papillary mucinous neoplasms (IPMNs), 4 neuroendocrine tumors, a chronic pancreatitis and a metastatic renal cell carcinoma. Among ten patients, pancreas tail in nine patients were left only on the splenic hilum at distal portion inside branching of the splenic vessel, and there was intraabdominal fluid collection which was naturally resolved. But other one patient with remnant pancreas tail above the hilar vessels re-admitted due to postoperative pancreatic fistula with fever, and underwent internal drainage. Conclusions: In spleen preservation, leaving small pancreas tail inside the splenic hilum would be feasible and more beneficial to the patient, rather than performing splenectomy in anatomically challenging patients.Tabled 1EP02E-00664/FPre-Op. : R/O PNETPost-Op. : Chronic pancreatitisSplenic vessel LigatedNo POPF5 days (Hosp. stay)X (Re-admission)49/MPNETPreservedBCL6X45/MIPMNLigatedBCL6X41/MPNETLigatedBCL7X56/FPNETPreservedNo5X38/MPNETLigatedBCL6X50/MIPMNLigatedGrade B8O74/MIPMNLigatedBCL10X61/MMetastatic renal cell ca.LigatedBCL7X25/FIPMNPreservedBCL7X Open table in a new tab