Spleen preserving laparoscopic distal pancreatectomy for treatment of pancreatic lesions

Abstract

AIM: Aim of this study is to evaluate the feasibility and safety of the laparoscopic approach in the treatment of distal pancreas tumors, from prospectively collected data.

MATERIAL OF STUDY: From January 2003 to July 2013, 20 patients were treated by laparoscopic approach for distal pancreatic lesions. Nine patients underwent laparoscopic pancreatic tumorectomy (LPT) (Group A) for insulinoma (mean lesion diameter 1.2 cm, range, 0.5-2) and 11 patients underwent spleen preserving laparoscopic distal pancreatectomy (SP-LDP) (Group B) for ductal adenocarcinoma (pT1N0R0) (1), cystic mucinous neoplasm (5), serous cystadenoma (4) and lymphoepithelial cysts (1).

RESULTS: Mean operative time was 94.3 minutes (range 80-110) for Group A and 164 minutes (range 90-240) for Group B. Intraoperative bleeding occurred in 4 cases (20%) and was easily controlled by laparoscopy. Conversion to open surgery was not required in any case. Morbidity was observed in 2 patients (18%) in Group A: pancreatic fistula (1) and peritoneal fluid collection (1); and a peritoneal fluid collection occurred in one patients (11%) in Group B. Mean hospital stay was 6.8 days (range 3-11) in Group A and 6.5 days (range 3-10) in Group B. Mortality was nil. At a mean follow-up of 82 months (range 15-141) local recurrence and distant metastases were not observed.

DISCUSSION: LDP is a valid treatment showing the same rate of complication to open surgery but allowing the advantages of a minimally invasive procedure.

CONCLUSIONS: SP-LDP is feasible and safe for benign and malignant pancreatic lesions.