Chapter 16. Distal Pancreatectomy

• 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).

Absolute

• 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.

Relative

• Cardiopulmonary comorbidities.
• Splenic vein thrombosis.

• 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.

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

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