Laparoscopic Distal Pancreatectomy with Division of the Pancreatic Neck for Benign and Borderline Malignant Tumor in the Proximal Body of the Pancreas

Abstract

Conventional laparoscopic distal pancreatectomy (DP) is now regarded as a safe, effective treatment modality; however, pancreatic transections are mostly believed to be somewhere between the body and tail of the pancreas. Laparoscopic DP, with its division at the pancreatic neck (subtotal pancreatectomy [STP]), is more challenging because there are major vascular structures, such as the celiac axis, coronary vein, and superior mesenteric vein-splenic vein-portal vein (SMV-SV-PV) confluence around the pancreatic neck portion to be dissected. Ten patients underwent laparoscopic STP with pancreatic division at the level of SMV-SV-PV confluence for benign and borderline pancreatic disease. Three patients were male and 7 were female, with a median age of 60 years (range, 28-73). All patients had benign or borderline malignant tumors in the body near the neck of the pancreas, with a median tumor size of 3 cm (range, 1-9.2). The operation time was a median of 287.5 minutes (range, 160-480). The intraopeative bleeding was a median of 300 mL (range, 100-700). Spleen preservation was carried out in 8 patients. Compared with open DP with the division of the pancreatic neck, a more frequent rate of spleen preservation (P = 0.004), longer operation time (P = 0.006), and early postoperative recovery presented by early intake of a soft diet (P = 0.001) and earlier discharge (P = 0.03) were significantly more frequent in the laparoscopic STP group. In a comparative study with laparoscopic DP, the longer segment of resected pancreas (P < 0.001), smaller amount of blood loss (P = 0.019), and high rate of spleen preservation (P = 0.019) were also noted in the laparoscopic STP group. Laparoscopic DP with division of the pancreatic neck is considered feasible and safe.