Safety and Efficacy of Laparoscopic Distal Pancreatectomy with Preservation of the Spleen and Splenic Vessels

비장 및 비장 혈관 보존 복강경 원위부 췌장 절제술의 안전성과 효용성

Purpose: Distal pancreatectomy has historically been accompanied by splenectomy, due to the proximity and common blood supply of the pancreas and spleen. However, spleen-preserving distal pancreatectomy was introduced in order to prevent postoperative sepsis. The aim of this study was to evaluate the feasibility and outcomes of spleen and splenic vessel preservation during laparoscopic distal pancreatectomy (LDP). Methods: Between June 2004 and March 2007, 30 patients underwent LDP for pancreatic neoplasms. Preservation of both the spleen and splenic vessels was pursued for benign and borderline malignant tumors. Results: There were 11 male and 19 female patients, with a mean age of 47 years (range; 24~79 years). In 4 patients with suspicious malignancy, the spleen and its vessels were sacrificed. Preservation of the spleen and its vessels was successfully performed in 20 of 26 patients (76.9%) in whom it was initially sought. The mean tumor size was 4.3 cm (range; 1.5~11 cm), the mean operation time was 231 min (range; 70~490 min), and the mean blood loss was 316.67 ml (range; 50~1000 ml). During LDP, no conversion to open surgery occurred. The mean hospital stay was 11 days (range; 6~23 days). There was no mortality or reoperation. Postoperative complications occurred in 9 patients (30%), but all patients recovered after conservative management. Conclusion: LDP is a relatively safe and feasible procedure for the management of benign or borderline malignant tumors of the distal pancreas. Preservation of the spleen and splenic vessels may be feasibly pursued during LDP.