title: Single-center experience of laparoscopic left pancreatic resection in 359 consecutive patients: changing the surgical paradigm of left pancreatic resection.
abstract: BACKGROUND
  Laparoscopic distal pancreatectomy (LDP) is increasingly performed for lesions of the body and tail of the pancreas. We analyzed the clinical characteristics of the largest series of patients to date who underwent LDP at a single center, as well as their outcomes, to reassess the surgical paradigm for left pancreatic resection.
  
  
  METHODS
  We retrospectively reviewed the records of 359 patients who underwent LDP at Asan Medical Center, Seoul, Korea, for pancreatic neoplasms between March 2005 and December 2010.
  
  
  RESULTS
  Of the 359 patients, 323 (90%) had benign or low-grade malignant neoplasms and 36 (10%) had malignancies. The most common diagnosis was intraductal papillary mucinous neoplasm (IPMN) in 72 patients (21.2%). There were 24 patients (6.7%) with pancreatic ductal adenocarcinoma (PDAC). We found that 178 patients (49.6%) underwent spleen-preserving LDP (SP-LDP): 150 (84.3%) by main splenic vessel preservation, and 28 (15.7%) supported by short gastric and gastroepiploic vessels (Warshaw technique). Postoperative complications occurred in 43 (12%) patients, including 25 (7%) with pancreatic fistula (ISGPF grade B, C), but there was no death. Median operative time was 195 (range, 78-480) min, and median postoperative hospital stay was 8 (range, 4-37) days. The proportion of patients with pancreatic lesions who underwent LDP increased from 8.6% in 2005 to 66.9% in 2010. Kaplan-Meier analysis showed that the 1- and 2-year overall survival rates in the 24 patients with PDAC were 85.2% each.
  
  
  CONCLUSIONS
  LDP is feasible, safe, and effective for the treatment of benign and low-grade malignant lesions of the pancreas. The increased use of LDP for left-sided pancreatic lesions, including malignant lesions, represents a paradigm shift from open distal pancreatectomy.
authors.affiliation: Department of Surgery, Ulsan University College of Medicine and Asan Medical Center, Songpa-ku, Seoul, South Korea.
authors.forename: Ki Byung
authors.initials: KB
authors.lastname: Song
authors.forename: Song Cheol
authors.initials: SC
authors.lastname: Kim
authors.forename: Jae Berm
authors.initials: JB
authors.lastname: Park
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Jung
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
authors.forename: Sung-Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Dong-Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.forename: Duck Jong
authors.initials: DJ
authors.lastname: Han
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013156:Splenectomy; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome