Abstract
Background
The diagnosis of low potential malignant diseases is increasingly frequent, and laparoscopic
central pancreatectomy can be indicated in these patients. Laparoscopic central pancreatectomy
that usually preserves the splenic vessels results in a low risk of new-onset diabetes
but high morbidity, mainly due to postoperative pancreatic fistula and postpancreatectomy
hemorrhage. In this study, we evaluated the short and long-term complications after
laparoscopic central pancreatectomy with splenic vessel resection.
Methods
This retrospective single-center cohort study included 650 laparoscopic pancreatic
resections from 2008 to 2020 with 84 laparoscopic central pancreatectomy; 15 laparoscopic
central pancreatectomy with splenic vessel resection; and 69 laparoscopic central
pancreatectomy with preservation of the splenic vessels. Pancreaticogastrostomy was
routinely performed, and the patients were discharged after complications had been
treated. The 15 laparoscopic central pancreatectomy with splenic vessel resection
were matched for age, sex, body mass index, and tumor characteristics [1:2] and compared
with 30 laparoscopic central pancreatectomy with the preservation of the splenic vessels.
Results
In the laparoscopic central pancreatectomy with splenic vessel resection group, resection
of splenic vessels was performed due to tumoral or inflammatory adhesions (n = 11) or accidental vascular injury (n = 4). The demographic characteristics of the groups were similar. Tumors were larger
in the laparoscopic central pancreatectomy with splenic vessel resection group (40
vs 21 mm; P = .008), and right transection on the body of the pancreas (53% vs 13%; P = .01) was more frequent. There were no differences in the characteristics of the
pancreas (Wirsung duct size or consistency). The median operative time (minutes) was
longer in the laparoscopic central pancreatectomy with splenic vessel resection group
than in the laparoscopic central pancreatectomy with preservation of the splenic vessels
group (210 vs 180, respectively; P = .15) with more blood loss (100 mL vs 50 mL, respectively; P = .012). The lengths (mm) of the resected pancreas and remnant distal pancreas in
the 2 groups were 65 vs 50 (P = .053) and 40 vs 65 (P = .006), respectively. There were no differences in postoperative mortality (0% vs
3%; P = .47), grade B–C postoperative pancreatic fistula (27% vs 27%; P = 1), reintervention (7% vs 13%; P = .50), grade B–C postpancreatectomy hemorrhage (0% vs 13%; P = .13), length of hospital stay (20 days vs 22 days; P = .15), or new-onset diabetes (7% vs 10%; P = .67) between the 2 groups.
Conclusion
Laparoscopic central pancreatectomy with splenic vessel resection is a safe technical
modification of central pancreatectomy that does not prevent preservation of the distal
pancreas and does not influence postoperative pancreatic fistula or endocrine insufficiency.
Furthermore, it could reduce the risk of postpancreatectomy hemorrhage.
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: July 18, 2022
Accepted:
May 10,
2022
Footnotes
The study was presented as a poster presentation at the EAHPBA 2021 (Bilbao-Spain) and at the IHPBA 2022 (New York, NY), and as an oral presentation at the Congress of the French Surgical Association, Paris, August 2021.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
