Outcome of laparoscopic surgery in patients with cystic lesions in the distal pancreas

Abstract

Context Recent guidelines for the management of cystic lesions of the pancreas recommend observation for selected neoplasms using imaging criteria. However, current imaging modalities lack diagnostic accuracy, and the indication for surgery is debated. Objective In this study we have explored the outcome of laparoscopic distal pancreatic resections in all patients referred with potential pancreatic cystic neoplasms, with histological diagnosis as endpoint. Methods Between 1997 and 2009 all patients referred to our tertiary referral centre having a cystic neoplasm of the distal pancreas accepted for surgery were included in the present observational study. Results A total of 69 patients were included. Sixty-two patients underwent distal pancreatectomies, in whom 19 were spleen-preserving, and 7 enucleations were performed. Two procedures were converted to open technique. The lesions removed in 27 patients (39%) were either malignant or premalignant. The final diagnoses were serous cystic neoplasm (n=29), mucinous cystic neoplasm (n=12), pseudocyst (n=11), solid pseudopapillary neoplasm (n=10), intraductal papillary mucinous neoplasm (n=5) and other (n=2). Overall morbidity was 33%; 56% of the complications were classified as mild. Fistula rate was 10%. One patient died postoperatively from a cerebral haemorrhage. Conclusion Most complications after laparoscopic distal resection of cystic pancreatic lesions are mild, but the proportion of patients with benign lesions (61%) has to be reduced by focused preoperative investigations. Endoscopic ultrasound examination (EUS), enabling aspiration of cyst fluid and fine needle aspiration is an additional option for the preoperative workup.