Distal Pancreatic Neoplasms: Is There a Role for Minimally-Invasive Surgical Procedures? Indications, Technique and Results on 32 Consecutive Patients Treated by the Same Surgical Team
Piccoli M1, Bassi C2, Butturini G2, Salvia R2, Falconi M2, Casetti L2, Pederzoli P2, Melotti GL1
1Department of General Surgical, S. Agostino Hospital. Modena, Italy. 2Department of Gastroenterological and Surgical Sciences, University of Verona. Verona, Italy
ABSTRACT
Background Distal pancreatic laparoscopic resection procedure is feasible and safe with results comparable with open resections even though post-operative fistula complication remains the most challenging problem.
Aim The aim of the study is to review our experience in order to confirm the feasibility and the safety of the procedure and to highlight the technique.
Methods Between May 1999 to May 2004 we performed 32 distal pancreatectomies for benign or border line cystic or solid tumors, 22 (69%) "spleen preserving" and 10 (31%) "spleen including". The technique includes supine decubitus, infragastric access, retrograde pancreatectomy in order to spare pancreatic healthy tissue and to preserve the splenic vessels, pancreatic section with endoGIA, drainage of the stump by a soft drain.
Results The mean operative time was 148 minutes (range 75-200) with no conversion rate and no blood transfusion. Eighteen out of 22 spleen preserving procedures were with splenic vessels preservation. There were 6 minor complications (18.7%): one trocar bleeding and 5 pancreatic fistulas resolved within 30 days without invasive procedures; 5 major complications (15.5%): one pancreatic fistula requiring CT guided drainage, one splenic infarction requiring splenectomy, 3 abdominal abscesses requiring re-operations. The overall reoperation rate was 12.5% with three open procedures and one laparoscopy. The mean hospital stay was 9 days (range 7-20) with no mortality.
Conclusion This experience of the same surgical team, the largest in the world to our knowledge, confirms that distal laparoscopic pancreatectomy is feasible and safe. The issue of the pancreatic stump management remains the most strong challenge for the surgeon either laparoscopic or open.
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