title: Laparoscopic Distal Pancreatectomy for Pancreatic Tumors: Does Size Matter?
abstract: BACKGROUND
  Laparoscopic distal pancreatectomy (LDP) for large pancreatic tumors may require prolonged dissection, and this could be associated with increased operative time and intraoperative complications.
  
  
  METHODS
  From a total cohort of 190 consecutive patients undergoing LDP, 18 patients were found to have pancreatic tumors >5 cm and were included in the retrospective study of prospectively collected data. Three techniques were used to approach the splenic vessels: the superior pancreatic, the inferior supracolic and post-pancreatic transection.
  
  
  RESULTS
  Of these 18 patients, 13 were women and 5 were men, the median age was 68 years and their median tumor size 7 cm. Exocrine pancreatic malignancy was diagnosed in 8 patients, 6 patients had neuroendocrine pancreatic tumors and 4 patients cystic neoplasm. The median number of resected nodes was 14. R1 resections for exocrine pancreatic malignancies were found in 50% of patients. Morbidity (grade >II) was found in 16.6% of patients and 30 days mortality in 1 patient. Overall median survival was 50 months and 29 months for patients with exocrine pancreatic malignancies.
  
  
  CONCLUSIONS
  LDP for large tumors, while technically demanding, is possible without additional morbidity and did not compromise short- and long-term oncological outcomes.
authors.affiliation: Department of Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Laureano
authors.initials: L
authors.lastname: Fernández-Cruz
authors.forename: Ignasi
authors.initials: I
authors.lastname: Poves
authors.forename: Amalia
authors.initials: A
authors.lastname: Pelegrina
authors.forename: Fernando
authors.initials: F
authors.lastname: Burdío
authors.forename: Santiago
authors.initials: S
authors.lastname: Sánchez-Cabus
authors.forename: Luis
authors.initials: L
authors.lastname: Grande
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000473:pathology / Q000601:surgery*; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden