title: Hand-assisted laparoscopic spleen-preserving distal pancreatectomy combined with laparoscopic distal gastrectomy for the treatment of pancreatic neuroendocrine tumor with early gastric cancer: Report of a case.
abstract: BACKGROUND
  In a distal pancreatectomy combined with a distal gastrectomy, the splenic artery and vein must be conserved. However, it is not easy in pure laparoscopic surgery. We performed a hand-assisted laparoscopic spleen-preserving distal pancreatectomy (HALS-SPDP) combined with a laparoscopic distal gastrectomy (LDG) for the treatment of a pancreatic neuroendocrine tumor (NET) with early gastric cancer.
  
  
  METHODS
  A 67-year-old male was hospitalized with no complaint. He was diagnosed with a pancreatic tail tumor (1.5cm in diameter) and early gastric cancer. He had undergone an endoscopic submucosal dissection (ESD). The pathohistology of the dissected tissue demonstrated that the histology was moderately differentiated adenocarcinoma, and the depth of the gastric cancer was pT1b2 (submucosal layer ∼1000μm). First, a pancreatectomy was performed extracorporeally under direct vision after detaching the spleen and the distal pancreas from the retroperitoneum under a hand-assisted laparoscopy. After the distal pancreatectomy, an LDG with a D1 lymphadenectomy was performed intracorporeally. The postoperative course was not eventful. Six months after surgery, an enhanced computed tomography (CT) scan revealed the patency of the splenic artery.
  
  
  CONCLUSIONS
  An HALS-SPDP combined with an LDG is beneficial and safe for the patients who have a pancreatic benign or low-grade malignant tumor and gastric cancer.
authors.affiliation: Department of Surgery, Kumamoto Regional Medical Center, Japan. Electronic address: sugitaf@ba2.so-net.ne.jp.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sugita
authors.affiliation: Department of Surgery, Kumamoto Regional Medical Center, Japan. Electronic address: kurokin76@hotmail.com.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kuroki
authors.affiliation: Department of Surgery, Kumamoto Regional Medical Center, Japan. Electronic address: theaki50220@gmail.com.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Akiyama
authors.affiliation: Department of Surgery, Kumamoto Regional Medical Center, Japan. Electronic address: d58nobuya624@gmail.com.
authors.forename: Nobuya
authors.initials: N
authors.lastname: Daitoku
authors.affiliation: Department of Surgery, Kumamoto Regional Medical Center, Japan. Electronic address: rumiko-tashima2015@krmc.or.jp.
authors.forename: Rumi
authors.initials: R
authors.lastname: Tashima
authors.affiliation: Department of Surgery, Kumamoto Regional Medical Center, Japan. Electronic address: hirotanaka-kmm@umin.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Surgery, Kumamoto Regional Medical Center, Japan. Electronic address: wjhhonda@hotmail.co.jp.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Honda
authors.affiliation: Department of Surgery, Kumamoto Regional Medical Center, Japan. Electronic address: mhirota@krmc.or.jp.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Hirota
keywords: Case report; Gastric cancer; Hand-assisted laparoscopic spleen-preserving distal pancreatectomy (HALS-SPDP); Laparoscopic distal gastrectomy (LDG); Pancreatic neuroendocrine tumor (NET)