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 laparoscopicpancreatectomy including distal pancreatectomy with splenectomy (DP), spleenpreservingdistal pancreatectomy (SpDP), enucleation, central pancreatectomy(CP), and single-incision laparoscopic surgery (SILS).Patients: From May 2005, we performed a total of 54 laparoscopicpancreatectomies (DP in 27, SpDP in 21, enucleation in 5, CP in 1). Indicationswere 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-neoplasticpancreatic 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 a5-mm flexible scope. In all distal pancreatectomies, the pancreas was resectedusing a liner stapler. In enucleation for NET, harmonic scalpel was employedfor pancreatic resection. For splenic preservation, as the basic technique, boththe splenic artery and vein were isolated and preserved. For the patients withsevere adhesion between the splenic vessels and the pancreatic parenchyma,Warshaw’s technique was used. In SILS, technical refinements such as gastricsuspension with stitches and splenic hilum hanging maneuver with a cloth tapewere 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, and9±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, therewas 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 twopatients with preoperative diagnoses of MCN and IPMN, respectively, had noninvasivecarcinoma. Another patient with SPT was also found to have limitedmicro-invasive lesion within the pancreatic parenchyma, thus diagnosed ascarcinoma. These three patients are now under close observation.Conclusions: Though laparoscopic distal pancreatectomy is a safe and optimalprocedure for benign/low-malignant lesion in the pancreas, special attentionshould be paid to their malignant potential.
