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Single-center experience of laparoscopic left pancreatic resection in 359 consecutive patients: changing the surgical paradigm of left pancreatic resection

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Abstract

Background

Laparoscopic distal pancreatectomy (LDP) is increasingly performed for lesions of the body and tail of the pancreas. We analyzed the clinical characteristics of the largest series of patients to date who underwent LDP at a single center, as well as their outcomes, to reassess the surgical paradigm for left pancreatic resection.

Methods

We retrospectively reviewed the records of 359 patients who underwent LDP at Asan Medical Center, Seoul, Korea, for pancreatic neoplasms between March 2005 and December 2010.

Results

Of the 359 patients, 323 (90%) had benign or low-grade malignant neoplasms and 36 (10%) had malignancies. The most common diagnosis was intraductal papillary mucinous neoplasm (IPMN) in 72 patients (21.2%). There were 24 patients (6.7%) with pancreatic ductal adenocarcinoma (PDAC). We found that 178 patients (49.6%) underwent spleen-preserving LDP (SP-LDP): 150 (84.3%) by main splenic vessel preservation, and 28 (15.7%) supported by short gastric and gastroepiploic vessels (Warshaw technique). Postoperative complications occurred in 43 (12%) patients, including 25 (7%) with pancreatic fistula (ISGPF grade B, C), but there was no death. Median operative time was 195 (range, 78–480) min, and median postoperative hospital stay was 8 (range, 4–37) days. The proportion of patients with pancreatic lesions who underwent LDP increased from 8.6% in 2005 to 66.9% in 2010. Kaplan–Meier analysis showed that the 1- and 2-year overall survival rates in the 24 patients with PDAC were 85.2% each.

Conclusions

LDP is feasible, safe, and effective for the treatment of benign and low-grade malignant lesions of the pancreas. The increased use of LDP for left-sided pancreatic lesions, including malignant lesions, represents a paradigm shift from open distal pancreatectomy.

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Acknowledgements

This work was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (grant number: E00264).

Disclosures

Ki Byung Song, Song Cheol Kim, Jae Berm Park, Young Hoon Kim, Young Soo Jung, Myung-Hwan Kim, Sung-Koo Lee, Dong-Wan Seo, Sang Soo Lee, Do Hyun Park and Duck Jong Han have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Ulsan University College of Medicine and Asan Medical Center, 388-1, Pungnap 2-dong, Songpa-ku, Seoul, 138-736, South Korea

    Ki Byung Song, Song Cheol Kim, Jae Berm Park, Young Hoon Kim, Young Soo Jung & Duck Jong Han

  2. Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

    Myung-Hwan Kim, Sung-Koo Lee, Dong-Wan Seo, Sang Soo Lee & Do Hyun Park

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  1. Ki Byung Song
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Song, K.B., Kim, S.C., Park, J.B. et al. Single-center experience of laparoscopic left pancreatic resection in 359 consecutive patients: changing the surgical paradigm of left pancreatic resection. Surg Endosc 25, 3364–3372 (2011). https://doi.org/10.1007/s00464-011-1727-9

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