title: Laparoscopic distal pancreatectomy with division of the pancreatic neck for benign and borderline malignant tumor in the proximal body of the pancreas.
abstract: BACKGROUND
  Conventional laparoscopic distal pancreatectomy (DP) is now regarded as a safe, effective treatment modality; however, pancreatic transections are mostly believed to be somewhere between the body and tail of the pancreas. Laparoscopic DP, with its division at the pancreatic neck (subtotal pancreatectomy [STP]), is more challenging because there are major vascular structures, such as the celiac axis, coronary vein, and superior mesenteric vein-splenic vein-portal vein (SMV-SV-PV) confluence around the pancreatic neck portion to be dissected.
  
  
  METHODS
  Ten patients underwent laparoscopic STP with pancreatic division at the level of SMV-SV-PV confluence for benign and borderline pancreatic disease.
  
  
  RESULTS
  Three patients were male and 7 were female, with a median age of 60 years (range, 28-73). All patients had benign or borderline malignant tumors in the body near the neck of the pancreas, with a median tumor size of 3 cm (range, 1-9.2). The operation time was a median of 287.5 minutes (range, 160-480). The intraopeative bleeding was a median of 300 mL (range, 100-700). Spleen preservation was carried out in 8 patients. Compared with open DP with the division of the pancreatic neck, a more frequent rate of spleen preservation (P = 0.004), longer operation time (P = 0.006), and early postoperative recovery presented by early intake of a soft diet (P = 0.001) and earlier discharge (P = 0.03) were significantly more frequent in the laparoscopic STP group. In a comparative study with laparoscopic DP, the longer segment of resected pancreas (P < 0.001), smaller amount of blood loss (P = 0.019), and high rate of spleen preservation (P = 0.019) were also noted in the laparoscopic STP group.
  
  
  CONCLUSIONS
  Laparoscopic DP with division of the pancreatic neck is considered feasible and safe.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine , Seoul, Korea.
authors.forename: Chang Moo
authors.initials: CM
authors.lastname: Kang
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Choi
authors.forename: Ho Kyoung
authors.initials: HK
authors.lastname: Hwang
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Kim
authors.forename: Chang Ik
authors.initials: CI
authors.lastname: Yoon
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods*; D010182:Pancreatic Diseases / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult