title: Laparoscopic distal pancreatectomy employing radical en bloc procedure for adenocarcinoma: Technical details and outcomes.
abstract: BACKGROUND
  Although laparoscopic distal pancreatectomy (LDP) has increasingly gained popularity, there are only a few reports mentioning application and outcomes of LDP for adenocarcinoma of the body and tail of the pancreas. The aim of our study is to demonstrate technical details of LDP employing radical en bloc procedure (en bloc LDP) and to evaluate the short- and long-term outcomes of en bloc LDP applied for adenocarcinoma.
  
  
  METHODS
  We evaluated 23 consecutive patients who underwent LDP for adenocarcinoma in the body or tail of the pancreas. Our concepts of en bloc LDP for adenocarcinoma comprise 3 principles: en bloc removal of retroperitoneal structures, lymph node (LN) dissection, and preservation of the spleen.
  
  
  RESULTS
  En bloc LDP without splenectomy was performed in 17 patients (74%) and en bloc LDP with splenectomy was in 6 patients (26%). Mean ± standard deviation operation time was 203 ± 54 minutes, and mean estimated blood loss was 208 ± 264 mL. Conversion to open distal pancreatectomy was required in 1 patient (4%) owing to the severe adhesions around the pancreas. The overall morbidity rate following en bloc LDP was 47% (n = 11), and the rate of pancreatic fistula was 39% (n = 9). There were no 30-day or in-hospital mortalities. Mean tumor size was 32 ± 12 mm, and mean number of harvested LNs was 19.8 ± 9.3. No patient had positive margins on final histologic diagnosis. The 1-, 3-, and 5-year overall survival rates were 67%, 49%, and 33%, respectively.
  
  
  CONCLUSIONS
  En bloc LDP can be applied safely by the surgeon with advanced experience in minimally invasive surgery with satisfactory short- and long-term outcomes, supporting further application of LDP for adenocarcinoma with advances in operative techniques and technological innovations.
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Yoshikuni
authors.initials: Y
authors.lastname: Kawaguchi
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France; Institut des Systèmes Intelligents et Robotique (ISIR), Université Pierre et Marie Curie, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.
authors.forename: Takeo
authors.initials: T
authors.lastname: Nomi
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.
authors.forename: Hughes
authors.initials: H
authors.lastname: Levard
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France; Institut des Systèmes Intelligents et Robotique (ISIR), Université Pierre et Marie Curie, Paris, France. Electronic address: brice.gayet@imm.fr.
authors.forename: Brice
authors.initials: B
authors.lastname: Gayet
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007902:Length of Stay; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010149:Postoperative Pain / Q000503:physiopathology; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome