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Distal pancreatectomy (body and tail)


Medical editor Bjørn Edwin MD
Cheif Physician
Specialist in Gastroenterological Surgery
Oslo University Hospital

Bård Røsok MD
Specialist in Gastroenterological Surgery
Oslo University Hospital

General

For cancer in the body or tail of the pancreas, a pancreatectomy can cure the disease. In a distal pancreatectomy, the spleen is also removed. 

Distal pancreatectomies at Oslo University Hospital, Rikshospitalet, are usually performed by a laparoscopic technique.

Indications

  • Detection or suspicion of cancer in the body or tail of the pancreas where there is no evidence of advanced cancer (metastasis or invasion of blood vessels). 
  • Precancerous conditions 

Goal

  • Cure the disease

Equipment

  • Laparoscopy rack
  • Ultrasound probe
  • Electrosurgical equipment (LigaSure®) or ultrasound scalpel (AutoSonix®, Harmonic® or SonoSurge®)
  • Laparatomy tray and possibly a vascular tray for the operating room

  • Preparation

  • Thrombosis prophylaxis
  • The patient lies in the supine position with their left side raised about 30°
  • The procedure is carried out under general anesthesia

  • Implementation

    • The first trocar (12 mm) is placed in the umbilicus. A total of 4 ports are routinely used. The last three are placed through the abdominal wall in an arc around the area of the tumor.
    • The left colon flexur is mobilized medially and the omental bursa is opened to expose the anterior distal end of the pancreas. For sufficient exposure, the stomach is mobilized medially and the transverse colon caudally, in order for the short gastric vessels between the speen and stomach as well as the gastrocolic ligament to be divided. 
    • Peroperative ultrasound is used to precisely localize the tumor.
    • The splenic artery and vein are dissected from the pancreas proximal to the tumor. The vessels are dissected to the origin of the splenic artery. The vessels are then split with a linear vessel stapler (artery before vein). In cases where the tumor invades toward neighboring organs - if there are no other contraindications - an èn-bloc resection of the infiltrated organs (adrenal gland, kidney, partial resection of colon and stomach) can be performed.
    • After resection the specimen is placed in an endocatch bag and pulled out in an extended umbilical incision.
    • Finally, a drain is installed near the incision on the pancreas, before closing the abdomen.

    Follow-up

    • The most common complication is leakage from the remainder of the pancreas. This is monitored by measuring amylase from the drain. A fistula is a complication which occurs when there is lasting production of larger fluid volumes with high levels of amylase from the drain. These usually close spontaneously over time (weeks to months). In some cases, the fluid production from the fistula can be reduced with octreotide analog drugs.
    • In uncomplicated cases, the patient may return home after about 5 days. If a fistula forms, the patient may return home with a drain installed.
    • The sutures are removed 2 weeks after the operation. 
    • Exocrine insufficiency can occur. This is treated with pancreatic enzymes in tablet form. In certain cases where large parts of the pancreas are removed, there is a small risk for developing diabetes. In this case, the patient will be dependent on insulin. 

    Further follow-up is determined based on the histology.


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