A Clinical Study Of Artery-First Approach In Laparoscopic Spleen-Preserving Distal Pancreatectomy

Objective To explore the surgical approach and safety of laparoscopic spleen-preserving distal pancreatectomy for benign,borderline tumor or low-grade malignancy of the pancreas.Methods 52 cases that who had undergone laparoscopic spleen-preserving distal pancreatectomy from October 2015 to December 2017 in Hepatobiliary and Pancreatic department,Zhejiang province people’s hospital were divided into two groups randomly.There were 25 cases in group A that adopted artery-first approach and 27 cases in group B that adopted left anterior pararenal space approach.To compare and analyze the differences between operation time,intraoperative bleeding,postoperative complications(such as pancreatic fistula and splenic infarction),postoperative hospital stay and so on.Spss18.0 software was used to analyze the inclusion data.Results 52 patients,including 18 males and 34 females,aged from 19 to 68 years old,and the average age is(39.71±11.84).There were no statistically significant differences between the two groups in terms of gender,age,ASA classification and tumor size.The average operation time of group A was(109.29±40.33)minutes and group B was(141.43±65.21)minutes,there was statistical difference(P<0.05).The average amount of intraoperative blood loss in group A was(114.28±73.68)ml while group B was(150.45±85.93)ml,there was statistical difference between the two groups(P<0.05).All of the 25 patients in group A retained the splenic vessels intact while 4 cases in group B were cut off because of excessive bleeding.There was no statistical difference between the two groups in spleen preserving(P>0.05).There was 1 case of postoperative splenic infarction in group A and 5 cases in group B,with statistical difference(P<0.05).There were 6 cases of biochemical leak in group A and 7 cases in group B,with no statistical difference(P>0.05).There was no statistical difference between the two groups in postoperative feeding time and postoperative hospital stay.Postoperative pathological diagnosis includes: 23 cases of serous cystadenoma,8 cases of mucinous cystadenoma,3 cases of neuroendocrine tumor,7 cases of intraductal papillary mucinous neoplasm,11 cases of solid pseudopapillary neoplasm.Conclusion The artery-first approach was safe and efficacious in laparoscopic spleen-preserving distal pancreatectomy.The concept of protecting the splenic vessels runs through the whole procedure and could effectively reduce the risk of splenic vascular injury and intraoperative hemorrhage.Besides,the splenic function can be fully protected by preserving splenic blood vessels intactly.The artery-first approach is worth promoting clinically.