Laparoscopic distal pancreatectomy with splenic preservation

Service de chirurgie digestive, hôpital Haut-Lévéque, groupe hospitalier Sud, avenue de Magellan, Bordeaux, France.
Journal of Visceral Surgery (Impact Factor: 1.32). 04/2010; 147(2):e25-31. DOI: 10.1016/j.jviscsurg.2010.05.001
Source: PubMed

ABSTRACT Background The technique of distal pancreatectomy has been well described, both with en bloc resection of the spleen and with splenic
preservation. Splenic preservation during pancreatic tail resection is desirable when oncologically appropriate, yet it is
technically challenging, particularly with laparoscopic approaches. Skeletonization of the splenic artery and vein is associated
with longer operative times and greater potential for bleeding. The authors report their experience with splenic preservation
during laparoscopic pancreatic resection using ligation of the splenic vessels and preservation of the short gastric vessels.

Methods A retrospective chart review was performed for all patients who underwent attempted laparoscopic pancreatic resection at Duke
University Medical Center from July 2002 to October 2005. Charts were analyzed for demographic information, length of hospital
stay, conversion, splenic preservation, and postoperative complications.

Results A total of 12 laparoscopic distal pancreatic resections were attempted for three men and nine women with a mean age was 55.8
years (range, 33–74 years). All 12 patients underwent distal pancreatectomy, 8 with splenic preservation. The spleen was removed
from three patients using splenic hilar lesions that prevented splenic salvage. One patient required splenectomy secondary
to more than 50% ischemia of the spleen. No patients with preoperatively diagnosed malignancy underwent splenic salvage. The
final pathologic diagnosis included neuroendocrine tumors (n = 2), cystic serous (n = 4) and mucinous (n = 2) neoplasms, intraductal papillary mucinous neoplasm (IPMN) (n = 1), pancreatitis (n = 2), and adenocarcinoma (n = 1). Two patients underwent conversion to open surgery for thickened parenchyma secondary to chronic pancreatitis (17%).
There were no other conversions. There were three chemical leaks (25%) diagnosed by elevated drain amylase and low volume
output, which were managed with intraoperatively placed drains removed at the initial postoperative clinic visit. There were
three higher volume leaks (25%) that required extended or percutaneous drainage, with eventual removal. The average blood
loss was 215 ml (range, 50–700 ml). The average operative time was 3 h and 41 min (range, 2 h 15 min to 5 h 58 min). The average
length of hospital stay was 4 days (range, 2–7 days).

Conclusion Splenic preservation should be performed when technically possible to decrease the morbidity of laparoscopic distal pancreatectomy.
The choice to ligate the splenic vessels allows for shorter operative times with minimal perioperative morbidity and blood
loss while maintaining the spleen.

1 Follower
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    ABSTRACT: Background The impact of splenectomy on outcomes after distal pancreatectomy was assessed in the present study, with a special emphasis on the postoperative systemic inflammatory response.Methods Thirty-three patients with spleen-preserving distal pancreatectomy—Kimura technique (SPDP group) were compared with a group of distal pancreatectomies with splenectomy (DPS group). The two groups were 1:1 matched for age, gender, co-morbidities and pathology.ResultsNo differences between the groups were observed regarding the overall/severe/infectious morbidity, pancreatic fistulae and postoperative diabetes rates (P-values ≥ 0.475). An increased blood loss (P = 0.031) and need for intraoperative transfusions (P = 0.004) was observed in the DPS group. Postoperative platelet count and platelet-to-lymphocyte ratio were significantly higher in the DPS group (P < 0.001).Conclusion Spleen removal during DP is not associated with a higher morbidity but with an increased blood loss and need for intraoperative transfusions. Although the postoperative systemic inflammatory response is higher when the splenectomy is performed, the number of postoperative infectious complications is not influenced. Preservation of the spleen during DP for benign and low-grade malignant tumor of the distal pancreas appears to be worthy and should be the first option whenever is technically feasible and it can be safely achieved.
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