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  • Distal pancreatic solid mass.
    • Neuroendocrine tumor.
    • Pancreatic adenocarcinoma.
    • Solid neoplasm of indeterminate diagnosis.
  • Distal pancreatic mucinous cystic neoplasms.
    • Asymptomatic, ≥ 3 cm in size.
    • Symptomatic, any size.
    • Presence of a solid component.
    • Dilated main pancreatic duct.
  • Distal pancreatic symptomatic serous cystadenoma.
  • Chronic calcific pancreatitis or small symptomatic pseudocyst limited to pancreatic tail (less common).

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Absolute

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  • Proximal mass requiring pancreatoduodenectomy.
  • Known metastatic disease.
  • Local invasion of structures that cannot be resected en bloc with the pancreas.
  • Mass encasing mesenteric vessels, with loss of usual fat planes noted on preoperative imaging (CT, MRI, or endoscopic ultrasound [EUS]).
  • Portal hypertension.

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Relative

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  • Cardiopulmonary comorbidities.
  • Splenic vein thrombosis.

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  • The patient should be supine.
  • The skin is prepared from the level of the nipples to the pubis, extending along the flank.
  • The abdomen is entered through a midline incision.
  • Alternatively, a bilateral subcostal incision may be used.

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  • Nothing by mouth with nasogastric tube decompression.
  • Oral diet is resumed following removal of the nasogastric tube and resolution of postoperative ileus.

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  • Pancreatic leak.
  • Pancreatic fistula.
  • Pancreatitis.
  • Surgical site infection.
  • Bleeding.

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