Laparoscopic Distal Pancreatectomy Preserving the Spleen and Splenic Vessels: An Operation Without Increased Morbidity

Kazuhiro Suzumura

doi:10.11648/j.js.20190704.15

Abstract

Background: The indications for laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and the associated morbidity in comparison to laparoscopic distal pancreatectomy with splenectomy (LDPS) are ill-defined. Objective: This study aimed to evaluate the safety, feasibility and outcomes of LSPDP. Methods: Between January 2010 and May 2014, 13 patients underwent LDPS or LSPDP in our institution, and their clinical data and the outcomes of the two procedures were retrospectively reviewed and statistically analyzed. Results: There were no significant differences in age, gender, American Society of Anesthesiologists (ASA) score, body mass index (BMI) or blood loss between the LDPS and LSPDP groups. The mean tumor size (8.63 vs. 2.51 cm, P<0.005) and mean operative time (353 vs. 235 minutes, P<0.029) were greater in the LDPS group than in the LSPDP group. The rates of complications in the two groups did not differ to a statistically significant extent. All of the patients were achieved R0 resection and no mortality. Conclusion: LSPDP with conservation of the splenic artery and vein was a safe and feasible option for benign or low-grade malignant tumors in the distal pancreas, because of no mortality, no splenic infarction and R0 resection. Splenic conservation does not significantly increase the morbidity associated with the procedure.

Highlights

Laparoscopic surgery has been developed to the extent that it is the standard technique for treating many conditions [1,2,3,4,5]
Laparoscopic distal pancreatectomy is accepted for benign and low-grade malignant tumors located in the distal pancreas [6,7,8,9,10]
In the laparoscopic distal pancreatectomy with splenectomy (LDPS) and laparoscopic spleen-preserving distal pancreatectomy (LSPDP) groups, there were no significant differences in gender, age, American Society of Anesthesiologists (ASA) score, body mass index (BMI) or blood loss; in the LDPS group, the tumor size was larger and the operative time was longer in comparison to the LSPDP group

Summary

Introduction

Laparoscopic surgery has been developed to the extent that it is the standard technique for treating many conditions [1,2,3,4,5]. Laparoscopic distal pancreatectomy is accepted for benign and low-grade malignant tumors located in the distal pancreas [6,7,8,9,10]. Irrespective of whether distal pancreatectomy is performed by open or laparoscopic procedures, the indications for spleen preservation are ill-defined. There have been many comparisons of open procedures, few reports have extensively compared laparoscopic spleen-preserving distal pancreatectomy (LSPDP) to laparoscopic distal pancreatectomy with splenectomy (LDPS). The indications for laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and the associated morbidity in comparison to laparoscopic distal pancreatectomy with splenectomy (LDPS) are ill-defined. Conclusion: LSPDP with conservation of the splenic artery and vein was a safe and feasible option for benign or low-grade malignant tumors in the distal pancreas, because of no mortality, no splenic infarction and R0 resection. Splenic conservation does not significantly increase the morbidity associated with the procedure

Objectives

Methods

Results

Conclusion