Laparoscopic multivisceral distal pancreatectomy

Abstract

Background: Laparoscopic distal pancreatectomy (LDP) with multivisceral resection can be a challenging procedure. Methods: This is the case of a 79 years old lady who presented with a 35 mm part cystic pancreatic tail mass with evidence of splenic vein occlusion and pancreatic tail atrophy, in keeping with pancreatic adenocarcinoma. A LDP and splenectomy was planned, however the intraoperative findings were of a mass in the body of pancreas invading into transverse mesocolon and posterior wall of the stomach. Results: A LDP with an en bloc wedge resection of the stomach and partial excision of the transverse mesocolon was performed. The operative time was 180 minutes, with 300 ml blood loss. The patient was discharged on postoperative day 3 with the drain in situ, which was removed 7 days after the operation in clinic. Histopathology showed well differentiated ductal adenocarcinoma pT3N0R0. We also present our results in 15 similar cases showing good short and long term outcomes. Conclusion: Laparoscopic multivisceral distal pancreatectomy is feasible and safe in expert hands even for oncological resections.