Laparoscopic spleen‐preserving distal pancreatectomy: A consecutive series at an experienced centre

Abstract

AimThe increasing experience within the area of laparoscopic procedures has paved the way for technically‐complex procedures, such as distal pancreatectomy. In order to avoid complications associated with concomitant splenectomy, these procedures are increasingly performed with spleen preservation. A drawback is the low number of cases, which does not allow for an evidence‐based comparison between laparoscopic and open procedures, and spleen‐preserving and concomitant splenectomy procedures.Patients and MethodsBetween 2006 and 2010, all data for patients who underwent a laparoscopic distal pancreatectomy (LDP) at the Department of Surgery, University of Schleswig‐Holstein, Luebeck, Germany, were collected are stored in a prospectively‐maintained database. Patients with tumours in the pancreatic tail and body that did not exceed the level of the portal vein were included in this database.ResultsA total of 22 patients who underwent LDP could be included in the evaluation. Ten of those patients underwent a laparoscopic spleen‐preserving distal pancreatectomy (LSPDP), while the remaining 12 received an LDP with splenectomy (LDPwS). The median operation time was 155 min (range: 98–253) for the LSPDP group, and 201 min (range: 60–310) for the LDPwS group (P = 0.06). The median hospital stay was 8.5 days (range: 5–23) in the LSPDP group compared to 11 days (range: 4–41) in the LDPwS group (P = 0.06). Pancreatic fistula occurred in two patients from each group. It caused an intraabdominal haemorrhage in one patient of the LSPDP group, which required re‐laparoscopy. Two patients experienced subphrenic abscesses in the LDPwS group and were treated interventionally. Histological examination revealed six cystadenomas and five pseudocysts (maximum diameter: 7 cm) in the LDPwS group, and six neuroendocrine tumours (maximum diameter: 2 cm) in the LSPDP group.ConclusionLDP can be performed safely. The optic magnification provided by laparoscopy facilitates LSPDP, as dissection of the splenic vessels can be avoided. Although not significant, there was a trend towards reduced hospital stay and operating time for LSPDP. Oncologic outcomes and morbidity seem to not be inferior to open procedures. The size of the tumours and the peripancreatic, as well as paraneoplastic, tissue alterations determine the indication for splenectomy.