Laparoscopic distal pancreatectomy

Abstract

Introduction: Laparoscopic distal pancreatectomy (LDP) is progressively expanding. The aim of this study is to report our experience regarding the benefit of the laparoscopic approach of varied distal pancreatic lesions. Methods: Between 2013 and 2019, a total of 34 LDP including 23 females (67.6%) and 11 males (32.4%) were carried out in our HPB Oncological Centre. Tumoral locations were: 16 in tail (47.1%), 12 in body (35.3%) and 6 (17.6%) in both tail and body. Size average of lesions was 44.1 mm (range: 17-120). LDP was carried out with the standard laparoscopic technique and the section, seal and close of the pancreatic parenchyma was performed with linear staplers. Results: No 90-day postoperative mortality occurred. In 9 out of 17 pancreatic closures with vascular linear staplers a type A pancreatic fistula (52.9%) was observed. But in 2 of 17 cases with visceral linear staplers the type A fistula rate was 11.8% (p = 0.026; IC 95% 1.22-92.48; OR: 7.88). Histopathological examination revealed 8 serous cystoadenomas, 6 mucinous cystoadenomas, 2 simple cysts, 3 IPMN type II, 8 ductal adenocarcinomas, 4 benign neuroendocrine tumors, 1 malignant neuroendocrine tumour, 2 metachronous metastasis (1 colorectal and 1 of renal cell carcinoma). In all cancer specimens the surgical margins were tumor free (R0). Conclusions: LDP is recognized worldwide as a feasible, safe and beneficial procedure. The closure of the pancreatic parenchyma with linear visceral staplers would appear to produce less pancreatic fistula than with vascular staplers. All fistulas were type A with easy postoperative management.