Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study.

BACKGROUND: The laparoscopic approach in distal pancreatectomy is associated with higher rates of splenic preservation compared to open surgery. Although favorable postoperative short-term outcomes have been reported in open spleen-preserving distal pancreatectomy when compared to distal pancreatectomy with splenectomy, it is unclear whether this observation applies to the laparoscopic approach. The aim of this study is to compare laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with laparoscopic distal pancreatectomy with splenectomy (LDPS). STUDY DESIGN: This is a UK wide, propensity score-matched study, including patients who underwent LSPDP or LDPS between 2006 and 2016. Short-term outcomes were compared between LSPDP and LDPS according to intention to treat. Additionally, risk factors for unplanned splenectomy were explored. RESULTS: A total of 456 patients were included from eleven centers (229 LSPDP and 227 LDPS). We were able to match 173 LSPDP cases to 173 LDPS cases, according to intention to treat. No differences were seen in postoperative morbidity between the groups. The only identified risk factor for unplanned splenectomy was tumor size ≥ 30 mm. CONCLUSIONS: Preserving the spleen during laparoscopic distal pancreatectomy is not associated with a lower postoperative morbidity compared to sacrificing the spleen. Tumor size is a risk factor for unplanned splenectomy.

Ciliated foregut cyst of the pancreas: another differential in the diagnosis of cystic pancreatic lesions.

CONTEXT: With the more frequent use of cross sectional imaging, the detection of cystic pancreatic incidentalomas has become a relatively common entity. The commonest cystic incidentalomas are neoplastic. Pseudocysts are the most single common pathological entity. Foregut cystic lesions as a pathological entity are rare but mostly observed in the mediastinum. Ciliated foregut cysts of the pancreas are very rare and an extremely uncommon cause of a cystic lesion within the pancreas. CASE REPORT: We present herewith an uncommon case of a large cystic lesion, confirmed as a ciliated foregut cyst on final histology arising from the body and tail of the pancreas. The lesion was very effectively treated with a laparoscopic distal pancreatectomy and splenectomy. CONCLUSION: The rarity of the lesion makes the case worth reporting.

A comparative review between laparoscopic and robotic pancreaticoduodenectomies.

In pancreatic surgery, there is an increasing interest in the feasibility of minimal access techniques. Robotic surgery has improved some limitations of standard laparoscopy and it is expected as a promising access. We provide a comparative review between laparoscopic and robotic pancreaticoduodenectomies. Between 1996 and 2013, we found 284 patients in the laparoscopic group and 147 in the robotic. Operative time, morbidity, and mortality were similar for both the groups (425.94 min, 30.28%, 2.19% in the laparoscopic group and 415.88 min, 36.78%, and 2.72% for the robotic arm, respectively). The mean hospital stay, mean estimated blood loss, fistula, and conversion rates were 11.09 days, 172,93 mL, 13.02%, and 5.63% and 13.84 days, 346.44 mL, 27.69%, and 11.56% for the laparoscopic and robotic group, respectively (P<0.05). Laparoscopic pancreaticoduodenectomy may confer benefits over robotic pancreaticoduodenectomies, although it is expected that outcomes of both modalities are likely to improve with greater experience and better patient selection.