Laparoscopic pancreatectomy for benign/ low-malignant tumors
- VernacularTitle:Дурангийн аргаар pancreatectomy хийж хоргүй ба хоруу чанар багатай хавдрыг эмчлэх нь
- Author:
Takeyuki Misawa
;
Katsuhiko Yanaga
- Publication Type:journal article
- From:Innovation
2014;8(4):138-139
- CountryMongolia
- Language:English
-
Abstract:
Background: We present the technical refinements of our laparoscopic
pancreatectomy including distal pancreatectomy with splenectomy (DP), spleenpreserving
distal pancreatectomy (SpDP), enucleation, central pancreatectomy
(CP), and single-incision laparoscopic surgery (SILS).
Patients: From May 2005, we performed a total of 54 laparoscopic
pancreatectomies (DP in 27, SpDP in 21, enucleation in 5, CP in 1). Indications
were benign/low-malignant lesions including mucinous cystic neoplasm (MCN),
neuroendocrine tumor (NET), intraductal papillary mucinous neoplasm (IPMN),
serous cystic neoplasm, solid and pseudopapillary tumor (SPT), non-neoplastic
pancreatic cyst, and splenic diseases.
Methods: For standard multiport surgery, 4-5 trocars were used. In SILS,
SILSTMPort was placed in the umbilicus for articulating instruments and a
5-mm flexible scope. In all distal pancreatectomies, the pancreas was resected
using a liner stapler. In enucleation for NET, harmonic scalpel was employed
for pancreatic resection. For splenic preservation, as the basic technique, both
the splenic artery and vein were isolated and preserved. For the patients with
severe adhesion between the splenic vessels and the pancreatic parenchyma,
Warshaw’s technique was used. In SILS, technical refinements such as gastric
suspension with stitches and splenic hilum hanging maneuver with a cloth tape
were applied.
Results: There was no conversion to open surgery. The mean operation time,
blood loss , and postoperative hospital stay were 277±95 min, 65±133 mL, and
9±3.6 days, respectively. Only 4 (7.4%) patient developed clinically significant
(grade B: 3, C:1) pancreatic fistula. In comparison between DP and SpDP, there
was no statistical difference in blood loss and complication rate. However,
operation time (299±820 vs. 229±78 min, p<0.05), postoperative hospital stay
(8.0±3.1 vs. 10.3±4.5 days, p<0.05), preoperative platelet count (363±126 vs.
227±41 ×103/μl, p<0.0005), and tumor size (58±36 vs. 30±15 mm, p<0.05)
were significantly different. Postoperative pathological study revealed that two
patients with preoperative diagnoses of MCN and IPMN, respectively, had noninvasive
carcinoma. Another patient with SPT was also found to have limited
micro-invasive lesion within the pancreatic parenchyma, thus diagnosed as
carcinoma. These three patients are now under close observation.
Conclusions: Though laparoscopic distal pancreatectomy is a safe and optimal
procedure for benign/low-malignant lesion in the pancreas, special attention
should be paid to their malignant potential.
