Distal pancreatectomy: Indications and outcomes in 235 patients

Objective Distal pancreatectomy is performed for a variety of benign and ma lignant conditions. In recent years, significant improvements in perioperat ive results have been observed at high-volume centers after pancreaticoduod enectomy. Little data, however, are available concerning the current indica tions and outcomes after distal pancreatectomy. This single-institution exp erience reviews the recent indications, complications, and outcomes after d istal pancreatectomy. Methods A retrospective analysis was performed of the hospital records of a ll patients undergoing distal pancreatectomy between January 1994 and Decem ber 1997, inclusive. Results The patient population (n = 235) had a mean age of 51 years, (range 1 month to 82 years); 43% were male and 84% white. The final diagnoses inc luded chronic pancreatitis (24%), benign pancreatic cystadenoma (22%), panc reatic adenocarcinoma (18%), neuroendocrine tumor (14%), pancreatic pseudoc yst (6%), cystadenocarcinoma (3%), and miscellaneous (13%). The level of re section was at or to the left of the superior mesenteric vein in 96% of pat ients. A splenectomy was performed in 84% and a cholecystectomy in 15% of p atients. The median intraoperative blood loss was 450 ml, the median number of red blood cell units transfused was zero, and the median operative time was 4.3 hours. Two deaths occurred in the hospital or within 30 days of su rgery for a perioperative mortality rate of 0.9%. The overall postoperative complication rate was 31%; the most common complications were new onset in sulin-dependent diabetes (8%), pancreatic fistula (5%)1 intraabdominal absc ess (4%), small bowel obstruction (4%), and postoperative hemorrhage (4%). Fourteen patients (6%) required a second surgical procedure; the most commo n indication was postoperative bleeding. The median length of postoperative hospital stay was 10 days. Patients who underwent a distal pancreatectomy with splenectomy (n = 198) had a similar complication rate (30% vs. 29%), o perative time (4.6 vs. 5.1 hours), and intraoperative blood loss (500 vs. 3 50 ml) and a shorter postoperative length of stay (13 vs. 21 days) than the patients who had splenic preservation (n = 37). Conclusions This series represents the largest single-institution experienc e with distal pancreatectomy. These data demonstrate that elective distal p ancreatectomy is associated with a mortality rate of <1%. These results dem onstrate that, as with pancreaticoduodenectomy, distal pancreatectomy can b e performed with minimal perioperative mortality and acceptable morbidity.