gms | German Medical Science

Background: Laparoscopic pancreas resections are performed increasingly in benign and malignant pancreatic disease. In contrast to benign lesions where laparoscopic distal pancreatectomy is an easy to perform procedure, distal pancreatectomy for adenocarcinoma is technically more challenging due to oncologic constraints.

Our aim is to demonstrate technical details for radical en bloc oncologic resections of the pancreatic body and tail for pancreatic adenocarcinoma including our laparoscopic closure of the pancreatic stump by parenchym-serosal patch.

Materials and methods: Between 2012 and 2015 148 distal pancreatectomies were performed. 46 were performed as laparoscopic procedures and 26 due to malignant tumors. 16 resections were performed due to NET, 9 for PDAC, and 1 for melanoma metastasis. Our concept for distal pancreatectomy for malignant disease is the en bloc resection of retroperitoneal structures. After placing the patient in French position the distal pancreas is resected en bloc with the fascia of Gerota and the adrenal gland. The left kidney and left renal vein is exosed. Lymphadenectomy is performed along the common hepatic artery, the celiac trunc. The neuroplexus to the left of the upper mesenteric artery is removed exposing the celiac trunc, upper mesentic artery and renal artery after resection. The pancreas is dissected with a high energy device, the area of the pancreatic duct secured by a non-absorbable suture and omega loop of the second jejunal loop is formed. A side-side jejunostomy is created and the jejunal loop serves as parenchym serosal patch being fixed by two running sutures.

Results: In 4 cases the resections were even extended by additional resection of the celiac trunc (Appleby operation), segmental resections of the small intestine, colon, diaphragm, and atypical stomach resection (2 cases). R0 resections were achieved in all cases that were resected laparoscopically due to a selection bias. The median of the number of examined lymph nodes was 14 (range 9-29). Median operation time was 312 minutes (range 220 – 410 minutes).

Conclusion: Radical resection of malignant tumors located in the pancreatic corpus and tail can be performed laparoscopically. Using minimally invasive techniques, the operative procedures should be performed similar to open practice.