Abstract
Purpose
To evaluate the indications for and the outcomes from distal pancreatectomy.
Methods
Retrospective chart review of 171 patients who underwent distal pancreatectomy at Brigham and Women’s Hospital between January 1996 and August 2005.
Results
Nearly one-third of distal pancreatectomies were performed as part of an en bloc resection for a contiguous or metastatic tumor. Fifty-six percent of the patients underwent a standard distal pancreatectomy +/− splenectomy (group 1), whereas 44% of distal pancreatic resections included additional organs or contiguous intraperitoneal or retroperitoneal tumor (group 2). The overall post-operative complication rate was 37%; the most common complication was pancreatic duct leak (23%). When compared to patients undergoing standard distal pancreatectomy, those with a more extensive resection including multiple viscera and/or metastatic or contiguous tumor resection had no significant difference in overall complication rate (35% v. 39%, p = 0.75), leak rate (25% v. 20%, p = 0.47), new-onset insulin-dependent diabetes mellitus (3% v. 4%, p = 1.0), and mortality (2% v. 4%, p = 0.656).
Conclusion
This series includes a large number of patients in whom distal pancreatectomy was performed as part of a multivisceral resection or with en bloc resection of contiguous tumor. Complications were no different in these patients when compared to patients undergoing straightforward distal pancreatectomy.
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References
Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 1999;229(5):693–700. doi:10.1097/00000658-199905000-00012.
Balcom JH, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 2001;136(4):391–398. doi:10.1001/archsurg.136.4.391.
Fahy BN, Frey CF, Ho HS, Beckett L, Bold RJ. Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg 2002;183:237–241. doi:10.1016/S0002-9610(02)00790-0.
Knaebel HP, Diener MK, Wente MN, Buchler MW, Seiler CM. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 2005;92:539–546. doi:10.1002/bjs.5000.
Sheehan MK, Beck K, Creech S, Pickleman J, Aranha GV. Distal pancreatectomy: does the method of closure influence fistula formation. Am Surgeon 2002;68:264–267.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138(1):8–13. doi:10.1016/j.surg.2005.05.001.
Pingpank JF Jr, Hoffman JP, Sigurdson ER, Ross E, Sasson AR, Eisenberg BL. Pancreatic resection for locally advanced primary and metastatic nonpancreatic neoplasms. Am Surgeon 2002;68:337–341.
Sperti C, Pasquali C, Liessi G, Pinciroli L, Decet G, Pedrazzoli S. Pancreatic resection for metastatic tumors to the pancreas. J Surg Oncol 2003;83:161–166. doi:10.1002/jso.10262.
Bilimoria MM, Cormier JN, Mun Y, Lee JE, Evans DB, Pisters PWT. Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg 2003;90:190–196. doi:10.1002/bjs.4032.
Rodriguez JR, Germes SS, Pandharipande PV, Gazelle GS, Thayer SP, Warshaw AL, et al. Implications and cost of pancreatic leak following distal pancreatic resection. Arch Surg 2006;141:361–366. doi:10.1001/archsurg.141.4.361.
Yao KA, Talamonti MS, Langella RL, Schindler NM, Rao S, Small Jr W, Joehl RJ. Primary gastrointestinal sarcomas: analysis of prognostic factors and results of surgical management. Surgery 2000;128(4):604–612. doi:10.1067/msy.2000.108056.
Kleeff J, Diener MK, Z’graggen K, Hinz U, Wagner M, Bachmann J, Zehetner J, Muller MW, Friess H, Buchler MW. Distal pancreatectomy. Risk factors for surgical failure in 302 consecutive cases. Ann Surg 2007;245(4):573–582. doi:10.1097/01.sla.0000251438.43135.fb.
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Poster presentation: DDW/SSAT Poster Session: Clinical/Pancreas—May 22, 2006 Los Angeles, CA.
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Irani, J.L., Ashley, S.W., Brooks, D.C. et al. Distal Pancreatectomy is Not Associated with Increased Perioperative Morbidity when Performed as Part of a Multivisceral Resection. J Gastrointest Surg 12, 2177–2182 (2008). https://doi.org/10.1007/s11605-008-0605-9
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DOI: https://doi.org/10.1007/s11605-008-0605-9