Laparoscopic spleen-preserving distal pancreatectomy: a report of 17 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Zhonghui , CHEN Hua , CHEN Hongze ,  SUN Bei

Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P. R. China;

Corresponding?author：

SUN Bei, Email: sunbei70@tom.com

Keywords：

pancreatic neoplasm; laparoscopic distal pancreatectomy; spleen-preservation

DOI：

10.7507/1007-9424.201801025

Video：

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Objective To evaluate feasibility and clinical application value of laparoscopic spleen-preserving distal pancreatectomy (LSPDP). Method The clinical data of 17 patients underwent LSPDP from January 2015 to June 2017 in this hospital were retrospectively analyzed. Results The LSPDP was successfully completed in the 17 cases, with Kimura procedure and Warshaw procedure were performed in the 12 cases and 5 cases, respectively. The operative time was (218±60) min, the intraoperative blood loss was (136±114) mL, the time to get out of bed after surgery was (1.4±0.6) d, the postoperative fasting time was (2.0±0.8) d, and the postoperative hospital stay was (13.4±5.7) d. The rate of the postoperative pancreatic fistula was 17.6% (3/17). The spleen infarction occurred in the 2 cases following the Warshaw procedure. The pathologic examination showed that there were 2 patients with the serous cystadenoma, 7 patients with the mucinous cystadenoma, 3 patients with the solid pseudo-papillary tumor, 3 patients with the intraductal papillary mucinous cystadenoma neoplasm, and 2 patients with the insulinoma. All the patients were followed-up for 5 to 26 months (average 13 months), and the perigastric varice occurred in 1 patient, no recurrence or spleen infarction occurred during the following-up. Conclusion LSPDP is a safe, feasible and effective method with less injury and rapid recovery.

Citation： LI Zhonghui, CHEN Hua, CHEN Hongze, SUN Bei. Laparoscopic spleen-preserving distal pancreatectomy: a report of 17 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(8): 929-933. doi: 10.7507/1007-9424.201801025 Copy

1.	Cuschieri A, Jakimowicz JJ, Van SJ. Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg, 1996, 223(3): 280-285.
2.	嚴加費, 牟一平, 徐曉武,等. 腹腔鏡胰體尾切除術 68 例單中心經驗. 中華外科雜志, 2012, 50(9):802-805.
3.	Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After.. Surgery, 2017, 161: 584-591.
4.	Kimura W, Moriya T, Ma J, et al. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Surgery, 1996, 120: 885-890.
5.	Kooby DA, Hawkins WG, Schmidt CM, et al. A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate?. J Am Coll Surg, 2010, 210(5): 779-785.
6.	Kooby DA, Chu CK. Laparoscopic management of pancreatic malignancies. Surg Clinics North Am, 2010, 90(2): 427-446.
7.	Addeo P, Giulianotti PC. Update on laparoscopic pancreatectomy in 2010. Minerva Chirurgica, 2010, 65(6): 655-66.
8.	Briggs CD, Mann CD. Systematic review of minimally invasive pancreatic resection. JGastrointestinal Surg, 2009, 13(6): 1129-1137.
9.	De RT, Sitarz R, Busch OR, et al. Technical aspects of laparoscopic distal pancreatectomy for benign and malignant disease: Review of the literature. Gastroenterology Res Prac, 2015, 2015: 472906.
10.	Richardson J, Di FF, Clarke H, et al. Implementation of enhanced recovery programme for laparoscopic distal pancreatectomy: feasibility, safety and cost analysis. Pancreatology, 2015, 15(2): 185-190.
11.	Adam J P, Jacquin A, Laurent C, et al. Laparoscopic spleen-preserving distal pancreatectomy: splenic vessel preservation compared with the Warshaw technique. JAMA Surg, 2013, 148(3): 246-252.
12.	Abu HM, Hamdan M, Di FF, et al. Laparoscopic versus open distal pancreatectomy: a clinical and cost-effectiveness study. Surg Endoscopy, 2012, 26(6): 1670-1674.
13.	Iacobone M, Citton M, Nitti D. Laparoscopic distal pancreatectomy: up-to-date and literature review.. World Journal of Gastroenterology, 2012, 18(38): 5329-5337.
14.	洪德飛, 林志川, 張宇華, 等. 腹腔鏡胰體尾切除術選擇策略臨床研究(附 56 例報告). 中國實用外科雜志, 2015, 35(12): 1325-1328.
15.	麻忠武, 俞海波, 陳峰, 等. 改良腹腔鏡下胰尾良性腫瘤切除術 12 例臨床分析. 中華胰腺病雜志, 2017, 17(1): 44-45.
16.	Matsushima H, Kuroki T, Adachi T, et al. Laparoscopic spleen-preserving distal pancreatectomy with and without splenic vessel preservation: The role of the Warshaw procedure. Pancreatology, 2014, 14(6): 530-535.
17.	Kimura W, Yano M, Sugawara S, et al. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein: techniques and its significance. J Hepato-Biliary-Pancreatic Sci, 2010, 17(6): 813-823.
18.	芮建銳, 楊新文, 韓瑋, 等. 腹腔鏡保留脾臟胰體尾切除術(附 7 例報道). 中國普外基礎與臨床雜志, 2015, 22(11): 1376-1378.
19.	Topgül K, Yürüker SS, Koca B, et al. Spleen-preserving laparoscopic distal pancreatectomy: Two cases and review of the technique. Ulusal Cerrahi Dergisi, 2013, 29(3): 139-143.
20.	Warshaw AL. Conservation of the spleen with distal pancreatectomy. Arch Surg, 1988, 123(5): 550-553.
21.	李世功, 裴愛華, 李汛,等. 保留脾臟的胰體尾切除術在臨床中的應用. 中國普外基礎與臨床雜志, 2013, 20(1): 70.
22.	孫志為, 馮幸子, 李星逾. 單孔腹腔鏡技術在胰腺疾病中的診治體會. 中國普外基礎與臨床雜志, 2016, 23(4): 403-405.
23.	Yu X, Li H, Jin C, et al. Splenic vessel preservation versus Warshaw’s technique during spleen-preserving distal pancreatectomy: a meta-analysis and systematic review. Langenbecks Arch Surg, 2015, 400(2): 183-191.
24.	Warshaw AL. Distal pancreatectomy with preservation of the spleen. J Hepato-Biliary-Pancreatic Sci, 2010, 17(6): 808-812.
25.	Ce?ka F, Jon B, Subrt Z, et al. Surgical technique in distal pancreatectomy: a systematic review of randomized trials. Bio Res Int, 2014, 2014(1): 482906.
26.	Knaebel HP, Diener MK, Wente MN, et al. Systematic review and meta‐analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg, 2005, 92(5): 539-546.
27.	Sahakyan M A, Kazaryan A M, Rawashdeh M, et al. Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients. Surg Endoscopy, 2016, 30(8): 3409-3418.
28.	Mehrabi A, Hafezi M, Arvin J, et al. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery, 2015, 157(1): 45-55.
29.	Diener MK, Knaebel HP, Witte ST, et al. DISPACT trial: a randomized controlled trial to compare two different surgical techniques of distal pancreatectomy study rationale and design. Clinical Trials, 2008, 5(5): 534-545.
30.	Baker M S, Bentrem D J, Ujiki M B, et al. A prospective single institution comparison of peri-operative outcomes for laparoscopic and open distal pancreatectomy. Surgery, 2009, 146(4): 635-643.
31.	陳華, 張廣權, 李軼龍, 等. 早期持續負壓引流在胰十二指腸切除術后胰瘺高危患者中的作用. 中華內分泌外科雜志, 2016, 10(6): 446-450.

1. Cuschieri A, Jakimowicz JJ, Van SJ. Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg, 1996, 223(3): 280-285.
2. 嚴加費, 牟一平, 徐曉武,等. 腹腔鏡胰體尾切除術 68 例單中心經驗. 中華外科雜志, 2012, 50(9):802-805.
3. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After.. Surgery, 2017, 161: 584-591.
4. Kimura W, Moriya T, Ma J, et al. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Surgery, 1996, 120: 885-890.
5. Kooby DA, Hawkins WG, Schmidt CM, et al. A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate?. J Am Coll Surg, 2010, 210(5): 779-785.
6. Kooby DA, Chu CK. Laparoscopic management of pancreatic malignancies. Surg Clinics North Am, 2010, 90(2): 427-446.
7. Addeo P, Giulianotti PC. Update on laparoscopic pancreatectomy in 2010. Minerva Chirurgica, 2010, 65(6): 655-66.
8. Briggs CD, Mann CD. Systematic review of minimally invasive pancreatic resection. JGastrointestinal Surg, 2009, 13(6): 1129-1137.
9. De RT, Sitarz R, Busch OR, et al. Technical aspects of laparoscopic distal pancreatectomy for benign and malignant disease: Review of the literature. Gastroenterology Res Prac, 2015, 2015: 472906.
10. Richardson J, Di FF, Clarke H, et al. Implementation of enhanced recovery programme for laparoscopic distal pancreatectomy: feasibility, safety and cost analysis. Pancreatology, 2015, 15(2): 185-190.
11. Adam J P, Jacquin A, Laurent C, et al. Laparoscopic spleen-preserving distal pancreatectomy: splenic vessel preservation compared with the Warshaw technique. JAMA Surg, 2013, 148(3): 246-252.
12. Abu HM, Hamdan M, Di FF, et al. Laparoscopic versus open distal pancreatectomy: a clinical and cost-effectiveness study. Surg Endoscopy, 2012, 26(6): 1670-1674.
13. Iacobone M, Citton M, Nitti D. Laparoscopic distal pancreatectomy: up-to-date and literature review.. World Journal of Gastroenterology, 2012, 18(38): 5329-5337.
14. 洪德飛, 林志川, 張宇華, 等. 腹腔鏡胰體尾切除術選擇策略臨床研究(附 56 例報告). 中國實用外科雜志, 2015, 35(12): 1325-1328.
15. 麻忠武, 俞海波, 陳峰, 等. 改良腹腔鏡下胰尾良性腫瘤切除術 12 例臨床分析. 中華胰腺病雜志, 2017, 17(1): 44-45.
16. Matsushima H, Kuroki T, Adachi T, et al. Laparoscopic spleen-preserving distal pancreatectomy with and without splenic vessel preservation: The role of the Warshaw procedure. Pancreatology, 2014, 14(6): 530-535.
17. Kimura W, Yano M, Sugawara S, et al. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein: techniques and its significance. J Hepato-Biliary-Pancreatic Sci, 2010, 17(6): 813-823.
18. 芮建銳, 楊新文, 韓瑋, 等. 腹腔鏡保留脾臟胰體尾切除術(附 7 例報道). 中國普外基礎與臨床雜志, 2015, 22(11): 1376-1378.
19. Topgül K, Yürüker SS, Koca B, et al. Spleen-preserving laparoscopic distal pancreatectomy: Two cases and review of the technique. Ulusal Cerrahi Dergisi, 2013, 29(3): 139-143.
20. Warshaw AL. Conservation of the spleen with distal pancreatectomy. Arch Surg, 1988, 123(5): 550-553.
21. 李世功, 裴愛華, 李汛,等. 保留脾臟的胰體尾切除術在臨床中的應用. 中國普外基礎與臨床雜志, 2013, 20(1): 70.
22. 孫志為, 馮幸子, 李星逾. 單孔腹腔鏡技術在胰腺疾病中的診治體會. 中國普外基礎與臨床雜志, 2016, 23(4): 403-405.
23. Yu X, Li H, Jin C, et al. Splenic vessel preservation versus Warshaw’s technique during spleen-preserving distal pancreatectomy: a meta-analysis and systematic review. Langenbecks Arch Surg, 2015, 400(2): 183-191.
24. Warshaw AL. Distal pancreatectomy with preservation of the spleen. J Hepato-Biliary-Pancreatic Sci, 2010, 17(6): 808-812.
25. Ce?ka F, Jon B, Subrt Z, et al. Surgical technique in distal pancreatectomy: a systematic review of randomized trials. Bio Res Int, 2014, 2014(1): 482906.
26. Knaebel HP, Diener MK, Wente MN, et al. Systematic review and meta‐analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg, 2005, 92(5): 539-546.
27. Sahakyan M A, Kazaryan A M, Rawashdeh M, et al. Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients. Surg Endoscopy, 2016, 30(8): 3409-3418.
28. Mehrabi A, Hafezi M, Arvin J, et al. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery, 2015, 157(1): 45-55.
29. Diener MK, Knaebel HP, Witte ST, et al. DISPACT trial: a randomized controlled trial to compare two different surgical techniques of distal pancreatectomy study rationale and design. Clinical Trials, 2008, 5(5): 534-545.
30. Baker M S, Bentrem D J, Ujiki M B, et al. A prospective single institution comparison of peri-operative outcomes for laparoscopic and open distal pancreatectomy. Surgery, 2009, 146(4): 635-643.
31. 陳華, 張廣權, 李軼龍, 等. 早期持續負壓引流在胰十二指腸切除術后胰瘺高危患者中的作用. 中華內分泌外科雜志, 2016, 10(6): 446-450.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Laparoscopic spleen-preserving distal pancreatectomy: a report of 17 cases

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