One-Hundred Laparoscopic Distal Pancreatectomies in a Single Institution
Creators: name: Nifosi, Jacopo
name: Aleotti, Francesca
name: Capretti, Giovanni
name: Pecorelli, Niccolò
name: Chiappetta, Sonja
name: Castoldi, Renato
name: Braga, Marco
name: Staudacher, Carlo
name: Balzano, Gianpaolo
Publisher: name: JOP. Journal of the Pancreas
Year: 2013
Subjects: Meeting Abstracts; Pancreas

description: <strong>Context</strong> The laparoscopic approach for benign and malignant lesions of the left pancreas is increasingly applied. <strong>Methods</strong> Retrospective study on prospectively collected data. Perioperative data and operative outcome of consecutive laparoscopic distal pancreatectomies performed between March 2006 and March 2013 were analyzed (intent-to-treat analysis). Operative outcome of the subgroup of patients with conversion to open surgery was compared to patients with successful laparoscopy to assess the consequences of conversion. <strong>Results </strong>Among 341 distal pancreatectomies, 100 patients (29%) had a laparoscopic approach (with a progressively increasing rate from 6% in 2006 to 62% in 2012). Malignancy was not a contraindication. Mean age was 57.4 years (range: 24-83 years; 42 males and 58 females). Mean BMI was 25.3 kg/m<sup>2</sup> (range: 17-39 kg/m<sup>2</sup>). Conversion rate was 19% (11 cases because of the difficulty to isolate the pancreas or lesion from the peripancreatic vessels, 6 cases due to intraoperative bleeding, 2 cases due to the site and/or dimension of the lesion). Mean operative time was 244 min (range: 110-490 min). Median blood loss was 250 mL (range: 30-1,800 mL), with 20 patients receiving blood transfusion. Mortality was nihil, morbidity was 68%, with 5% grade ≥3 according to Clavien-Dindo classification (2 cases percutaneous drainage, 3 cases relaparotomy). Pancreatic fistula occurred in 55 cases (of which 8 grade B, 1 grade C). Mean postoperative stay was 8.2 days (range: 4-23 days). Readmission occurred in 7 cases. Spleen preservation (performed with preservation of splenic vessels) was planned in 64% of cases and was successful in 48%; in 12 cases splenectomy was intraoperatively decided due to adhesions with splenic vessels, in 4 cases due to bleeding. The 19 patients with conversion to open surgery, when compared to patients without conversion, had a longer operative time (P=0.01), higher blood loss (P&lt;0.001), higher transfusion amount (P&lt;0.001), and longer postoperative stay (P=0.001); no difference was observed in morbidity rate (P=0.42). At final histology 25 cases were adenocarcinoma, 33 NET (9 insulinoma), 23 cystoadenoma (17 mucinous, 6 serous), 8 IPMN, 5 solid pseudopapillary tumors, 4 chronic pancreatitis and pseudocysts, 2 metastases from RCC. R0 resection was obtained in 97% of cases. Mean number of retrieved lymph nodes was 14.4. <strong>Conclusions</strong> Laparoscopic distal pancreatectomy can be performed in more than 60% of overall distal pancreatectomy, with a successful spleen preservation rate of 75% of cases. A worse operative outcome is to be expected in patients requiring conversion to open surgery.
description: JOP. Journal of the Pancreas, Vol 14, N° 5S (2013): September (Suppl.) - p. 528-602