Position of the Pancreas Division Line and Postoperative Outcomes After Distal Pancreatectomy.

BACKGROUND: In distal pancreatectomy (DP), the position of the pancreas division line (PDL) changes depending on the location or nature of the tumor. Here, we investigated the relationship between PDL and postoperative complications after DP. METHODS: We retrospectively analyzed data of 140 patients who underwent DP at Tokyo Medical and Dental University Hospital between January 2011 and September 2018. PDL was defined as the distance from the left margin of the portal vein to the edge of the pancreatic stump on the coronal plane of computed tomography. RESULTS: The mean PDL was 15.1 (range 0-74.3) mm. PDL was significantly longer in patients with portal venous system thrombosis (PVST) than in those without PVST (47.6 vs. 0 mm, p < 0.001). The PDLlong (≥ 20 mm) group underwent surgery with a significantly shorter duration (253 vs. 294 min, p < 0.001) and experienced a lower volume of blood loss (20 vs. 256.5 mL, p < 0.001) than the PDLshort (< 20 mm) group. Six months after surgery, the increase in HbA1c level was significantly higher in the PDLshort group than in the PDLlong group (0.5 vs. 0.35%, p = 0.041). Except for PVST, there was no significant difference in postoperative complications between the two groups. CONCLUSIONS: In DP, pancreas resection with a longer PDL resulted in a significantly shorter duration of surgery, lower estimated blood loss, and superior glucose tolerance than that with a shorter PDL.