Journal of the American College of Surgeons
-
As compared with open distal pancreatectomy, laparoscopic distal pancreatectomy (LDP) is associated with lower morbidity and shorter hospital stays. Existing reports do not elucidate trends in patient selection, technique, and outcomes over time. We aimed to determine outcomes after LDP at a specialized center, analyze trends of patient selection and operative technique, and validate a complication risk score (CRS). ⋯ This large, single-institution series demonstrates that despite a shift in patient selection to sicker patients with more proximal tumors, similar perioperative outcomes can be achieved with laparoscopic distal pancreatectomy. The CRS appears to be a reliable preoperative assessment tool for assessing other adverse perioperative outcomes in addition to predicting overall complications and fistulas as originally published.
-
Pancreatectomy with aggressive vascular resection is increasingly being recognized as an appropriate treatment strategy for patients with borderline resectable PDAC after administration of chemotherapy and/or chemoradiation. Because tumor downstaging is an uncommon event, both venous and hepatic arterial resection and reconstruction might be necessary to achieve negative surgical margins and the favorable short-term and long-term outcomes we have reported previously. The technical approaches we have described here can be used as a basic foundation for operative safety and efficiency during these challenging operations.