Improvement in distal pancreatectomy for tumors in the body and tail of the pancreas

Abstract

Background Pancreatic resections are complex and technically challenging surgical procedures. They often come with potential limitations to high-volume centers. Distal pancreatectomy is a relatively simple procedure in most cases. It facilitates the development of up-to-date minimally invasive surgical procedures in pancreatic surgery including laparoscopic distal pancreatectomy and robot-assisted distal pancreatectomy. Main body To obtain a desirable long-term prognosis, R0 resection and adequate lymphadenectomy are crucial to the surgical management of pancreatic cancer, and they demand standard procedure and multi-visceral resection if necessary. With respect to combined organ resection, progress has been made in evaluating and determining when and how to preserve the spleen. The postoperative pancreatic fistula, however, remains the most significant complication of distal pancreatectomy, with a rather high incidence. In addition, a safe closure of the pancreatic remnant persists as an area of concern. Therefore, much efforts that focus on the management of the pancreatic stump have been made to mitigate morbidity. Conclusion This review summarized the historical development of the techniques for pancreatic resections in recent years and describes the progress. The review eventually looked into the controversies regarding distal pancreatectomy for tumors in the body and tail of the pancreas.

Distal pancreatectomy

“…Besides that, hospital stay was also shorter in comparison to open surgery. Nevertheless, there was no significant difference in postoperative morbidity, including pancreatic fistula development, documented (7). However, the most important question remained the preservation of radicality in the case of the minimally invasive option used.…”

International consensus guidelines on robotic pancreatic surgery in 2023

“…Comments: during a DP, both staplers, as well as non-stapler closure, are used for pancreatic stump closure and no differences were observed between both methods in previous studies ( 114 , 115 ). In RDP, stapler and non-stapler closure are both technically safe and feasible ( 116 , 117 ). A recent study demonstrated that RDP with a reinforced stapler could potentially lead to reduced POPF rates ( 118 ).…”

Short-Term Outcomes of Conventional Laparoscopic versus Robot-Assisted Distal Pancreatectomy for Malignancy: Evidence from US National Inpatient Sample, 2005–2018

“…There are several surgical interventions, including pancreatoduodenectomy (commonly known as the Whipple procedure), pylorus-preserving pancreaticoduodenectomy, and distal pancreatectomy [ 5 , 6 ]. Distal pancreatectomy is a procedure that is used to manage benign and malignant lesions in the body or tail of the pancreas [ 7 , 8 ]. This operation entails the removal of the left-of-midline portion of the pancreas, with the duodenum and distal bile duct remaining outside the excised area [ 8 ].…”