Distal pancreatic resection - Indications, techniques and complications

Aim: Description of the indications, surgical technique and postoperative complications of distal pancreatic resection. Methods: We analyzed the prospectively documented perioperative data of 41 patients undergoing distal pancreatectomy between 1994 and 2001. Indications for resection were chronic pancreatitis (n = 21), malignant or benign tumors (n = 19) and others (n = 1). Results: Median operation time was 4.5 hours, a Y-Roux-pancreaticojejunostomy was performed in 66%. Further organs were resected in 93%, most frequently in form of splenectomy. A malignant vascular invasion led to positive resection margins in three patients. Mortality was 2 %. Postoperative complications occurred in 41 % with 15 % revealing pancreatic leakage. A relaparotomy was carried out in 20%. Pancreatic leakage was more frequently seen in the first part of the study period and after oversewing of the pancreatic stump. A new onset diabetes occurred postoperatively in 6% of the patients. Conclusions: Distal pancreatectomy can be carried out with low mortality, despite a high complication rate. The probability of postoperative diabetes is low. The frequency of pancreatic leakage may be reduced significantly by increasing hospital experience. The management of the pancreatic stump by pancreatojejunostomy should be considered in patients with a high risk of pancreatic leakage.