Laparoscopic Distal Pancreatico-Splenectomy for Mucinous Cystic Neoplasm of Pancreas

Abstract

Introduction: Mucinous cystic neoplasms are rare premalignant tumors of the pancreas and account for 1–2% of all pancreatic tumors. Surgical removal before invasive malignancy offers the best long-term outcome.1 Distal pancreatectomy with or without spleen preservation remains the standard procedure. Although an open technique is still the most commonly used approach, laparoscopy is associated with less pain, less blood loss, less morbidity, similar clinical outcomes, and an early return to activities.2,3 This video presents a laparoscopic distal pancreaticosplenectomy (LDPS) performed for a mucinous cystic neoplasm in the body of pancreas. Materials and Methods: A 30-year-old lady presented with a 2-year history of recurrent epigastric pain that had increased in severity over the past 2 months and required admission. Her physical examination was normal. A contrast-enhanced computed tomogram revealed a 3 × 3 cm well-defined cystic lesion in the tail of the pancreas adherent to the splenic vein. An endoscopic ultrasonography with fine needle aspirate revealed a complex cystic mucinous cystic neoplasm measuring 2.8 × 2.5 cm in the body of the pancreas. Owing to its premalignant potential and recurrent symptoms, an LDPS was performed for the mucinous cystic neoplasm of the body of pancreas. Vaccinations covering Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae were administered 2 weeks before surgery. The patient was placed in a French position with ports as shown in the video. Spleen preservation was not attempted because of the splenic vein involvement. The pancreas was divided using a stapler and the vessels were divided using sequential clips. The pancreas was separated from the spleen as it was a nonmalignant lesion and enabled easy removal from the port site without enlarging the incision or morcellation. Results: The operative time was 90 minutes with <10 mL of blood loss. The perioperative course was uneventful, and her diet was resumed on postoperative day 1. The drain was removed on postoperative day 3 after an insignificant drain amylase. The patient was discharged on postoperative day 4. Final histopathology report revealed a low-grade mucinous cystic neoplasm of the pancreas. The patient is asymptomatic at 3 months follow-up. Conclusion: LDPS is a safe and feasible approach for mucinous cystic neoplasms of pancreas. It provides less pain, lower blood loss, and early return to work to the patient while providing similar outcomes. The authors have no commercial associations resulting in conflict of interest with respect to the submitted video. Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 9 mins 57 secs This video was presented and awarded third best video presentation at SURGICON 2022 (Annual conference of Association of Surgeons of India—Delhi Chapter) on November 13, 2022.