Laparoscopic central pancreatectomy: Results in 81 patients

Abstract

Presenter: Safi Dokmak | Beaujon Hospital Background: Low potential malignant diseases are more frequently discovered and when surgery is indicated, parenchymal sparing resection is recommended to avoid long term endocrine and exocrine insufficiency. For centrally located lesions, central pancreatectomy (CP) can be indicated; however this one is not frequently performed related to higher morbidity compared to distal pancreatectomy. When CP is indicated, the laparoscopic approach is a good indication as the technical applicability rate is very high related to the absence of oncological or vascular contraindication. The aim of this study was to analyze our monocentric experience. Methods: Between 2008-2018, 540 laparoscopic pancreatic resections were performed in our department and 81 patients underwent laparoscopic CP. CP was indicated if enucleation was not feasible, in non-diabetic patients and if the distal pancreas was > 5 cm. The laparoscopic approach compared to the open approach was applied according to the surgeon experience and was nearly 100% with laparoscopic surgeons. The pancreas was divided on the neck by stapler when possible, the distal pancreas was mobilized and sectioned 1 cm to the left of the tumor with frozen section when indicated. One layer Pancreato-gastric anastomosis was fashioned and the nasogastric tube was left for 5 days with parenteral nutrition. All patients with pancreatic fistula were managed in the hospital until complete healing. All clinical, operative and postoperative data were recorded prospectively and were analyzed. Results: The mean age was 50 (17-77), including 55 female (68%), with a mean BMI at 25 (16-36) and 17 (21%) were obese. Indications for resection were for neuroendocrine tumor (24; 30%), IPMN (16; 20%), solid pseudopapillary tumor (12; 15%), mucinous cystadenoma (11; 14%), pancreatitis with disconnected duct syndrome (5; 6%), adenocarcinoma (3; 4%) and other (10; 11%). In patients with adenocarcinoma, the diagnosis was made postoperatively and completion distal pancreatectomy was done few weeks later. The mean operative time was 183 (90-285), the mean blood loss 107 (0-800), one transfusion (1%), and one conversion (1%) in the early experience. The pancreas was hard in 37 patients (46%). No 90 days mortality and the overall morbidity was observed in 58 patients (72%) including grade B/C pancreatic fistula (21; 26%), bleeding (10; 12%) which was severe in 5 (6%), drained collection (2; 3%), delayed gastric emptying (2; 3%), re-intervention (5; 6%), and pulmonary complications (3; 4%). the mean hospital stay was 22 days (5-54) with readmission in 2 (2%). The mean number of harvested lymph nodes was 3 (0-19) including 18 (22%) patients with zero harvested lymph nodes. Lymph nodes were only invaded in patients who turned to have adenocarcinoma. Resection was R0 in 71 (88%) patients. Conclusion: The applicability of laparoscopic central pancreatectomy is high and the morbidity is acceptable. There is a real advantage on the preservation of the pancreatic function and abdominal wall in these young patients with no malignancy.