Updated outcomes using clockwise technique for laparoscopic distal pancreatectomy: Optimal treatment of benign and malignant disease of the left pancreas

Abstract

Background: Laparoscopic distal pancreatectomy (LDP) has become the preferred approach for surgical management of left sided pancreas pathology. Our institution previously published its experience with distal pancreatectomies using a clockwise technique with good outcomes. We now reexamine our outcomes across a longer time interval. Methods: From August 2008 to November 2020, 364 patients underwent LDP by hepatobiliary surgeons (HA and JS). All procedures were performed using the same clockwise approach, which includes the stepwise slow compression technique. Retrospective descriptive analysis of patient demographic, clinical, operative, and pathologic data was conducted. Results: Of the 364 patients who underwent LDP using this technique, clinically significant postoperative pancreatic fistula (POPF) was noted in 26 (7.1%) patients, while major morbidity and mortality were reported in 9.9% and 0.3%, respectively. Hand-assisted method was required for 18 (4.9%) patients and unplanned conversion in 20 (5.5%) patients. In a subset analysis of patients with pancreatic adenocarcinoma (n = 90), POPF was noted in 13 (14.4%), with minor complications occurring in 34.4% and major morbidity in 14.4%. Conclusion: LDP with a clockwise approach for dissection, combined with the stepwise slow compression technique results in excellent outcomes, with even lower POPF rates than originally reported. Subset analysis of patients with pancreatic adenocarcinoma shows acceptable perioperative outcomes with this technique.

Keywords

• Laparoscopic distal pancreatectomy
• Pancreatic ductal adenocarcinoma
• Outcomes