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Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas.
J Gastrointest Surg. 2004 May-Jun; 8(4):493-501.JG

Abstract

The precise role of laparoscopy in the resection of cystic neoplasms of the pancreas (CyNP) remains unknown. In addition, the question of spleen-preserving distal pancreatectomy is controversial. This report evaluates the feasibility and outcome of laparoscopic spleen-preserving distal pancreatectomy (LapSPDP) in 19 patients (17 women and 2 men) with CyNP. A prospective comparison was made between 11 consecutive patients (group I) with splenic vessel preservation (SVP) and 8 patients (group II) without SVP (Warshaw technique). This study used color-Doppler ultrasound (CDUS) as a tool to identify patients at high risk for postoperative splenic complications. The mean tumor size was, in both groups, 5 cm. In group I, with an intent-to-treat basis of SVP, only in 54.5% of patients the spleen was preserved with an intact splenic artery and vein; in the remainder, conversion to the Warshaw technique was required for intraoperative bleeding. Evaluation of intraoperative factors showed that the mean operative time was significantly shorter (165 vs. 222 minutes) and the mean blood loss significantly lower (225 vs. 495 mL) in the group of LapSPDP with the Warshaw technique. No patients required blood transfusion in both groups. The overall conversion rate was 0%. The overall rate of pancreatic fistula was 15% and it was classified as biochemical leak (no clinical symptomatology). Overall splenic complications were observed in 16.6% of patients but occurred only in three patients undergoing LapSPDP with the Warshaw technique; CDUS showed in 2 patients a focal splenic infarct; the third patient had an initial hospital stay of 5 days, was readmitted 2 days later for a massive splenic necrosis, and splenectomy was performed. The overall hospital stay was 5.7 days. At mean follow up of 22 months (range 6-42), there have been no local recurrences.

Authors+Show Affiliations

Department of Surgery, IMD, Hospital Clinic i Provincial de Barcelona, Barcelona, Spain. lfcruz@clinic.ub.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15120376

Citation

Fernández-Cruz, Laureano, et al. "Laparoscopic Distal Pancreatectomy Combined With Preservation of the Spleen for Cystic Neoplasms of the Pancreas." Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, vol. 8, no. 4, 2004, pp. 493-501.
Fernández-Cruz L, Martínez I, Gilabert R, et al. Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg. 2004;8(4):493-501.
Fernández-Cruz, L., Martínez, I., Gilabert, R., Cesar-Borges, G., Astudillo, E., & Navarro, S. (2004). Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, 8(4), 493-501.
Fernández-Cruz L, et al. Laparoscopic Distal Pancreatectomy Combined With Preservation of the Spleen for Cystic Neoplasms of the Pancreas. J Gastrointest Surg. 2004 May-Jun;8(4):493-501. PubMed PMID: 15120376.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. AU - Fernández-Cruz,Laureano, AU - Martínez,Isidro, AU - Gilabert,Rosa, AU - Cesar-Borges,Gleydson, AU - Astudillo,Emiliano, AU - Navarro,Salvador, PY - 2004/5/4/pubmed PY - 2004/10/27/medline PY - 2004/5/4/entrez SP - 493 EP - 501 JF - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract JO - J Gastrointest Surg VL - 8 IS - 4 N2 - The precise role of laparoscopy in the resection of cystic neoplasms of the pancreas (CyNP) remains unknown. In addition, the question of spleen-preserving distal pancreatectomy is controversial. This report evaluates the feasibility and outcome of laparoscopic spleen-preserving distal pancreatectomy (LapSPDP) in 19 patients (17 women and 2 men) with CyNP. A prospective comparison was made between 11 consecutive patients (group I) with splenic vessel preservation (SVP) and 8 patients (group II) without SVP (Warshaw technique). This study used color-Doppler ultrasound (CDUS) as a tool to identify patients at high risk for postoperative splenic complications. The mean tumor size was, in both groups, 5 cm. In group I, with an intent-to-treat basis of SVP, only in 54.5% of patients the spleen was preserved with an intact splenic artery and vein; in the remainder, conversion to the Warshaw technique was required for intraoperative bleeding. Evaluation of intraoperative factors showed that the mean operative time was significantly shorter (165 vs. 222 minutes) and the mean blood loss significantly lower (225 vs. 495 mL) in the group of LapSPDP with the Warshaw technique. No patients required blood transfusion in both groups. The overall conversion rate was 0%. The overall rate of pancreatic fistula was 15% and it was classified as biochemical leak (no clinical symptomatology). Overall splenic complications were observed in 16.6% of patients but occurred only in three patients undergoing LapSPDP with the Warshaw technique; CDUS showed in 2 patients a focal splenic infarct; the third patient had an initial hospital stay of 5 days, was readmitted 2 days later for a massive splenic necrosis, and splenectomy was performed. The overall hospital stay was 5.7 days. At mean follow up of 22 months (range 6-42), there have been no local recurrences. SN - 1091-255X UR - https://www.unboundmedicine.com/medline/citation/15120376/Laparoscopic_distal_pancreatectomy_combined_with_preservation_of_the_spleen_for_cystic_neoplasms_of_the_pancreas_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1091255X03002968 DB - PRIME DP - Unbound Medicine ER -