Spleen-preserving pancreatectomy for cystic pancreatic neoplasms

Cystic neoplasms of the pancreas are an uncommon entity comprising fewer th an 1 per cent of all pancreatic neoplasms. The guidelines for management of these tumors, specifically, the extent of resection, are unclear. Formerly , a distal pancreatectomy including the spleen was performed for tumors in the tail of the pancreas. The importance of preserving the spleen has been well documented; however, there are few reports of spleen-preserving pancre atectomy for cystic neoplasms of the distal pancreas. We report two patient s who underwent spleen-preserving pancreapancreatectomy for mucinous cystic neoplasms in the tail of the pancreas. Both patients were female, ages 39 and 65 years. Preoperative preparation included administration of vaccinati ons and subcutaneous somatostatin. Operative technique emphasized division of the splenic artery and vein beyond the tip of the distal pancreas withou t mobilization of the spleen. The pancreas was transected with a vascular s tapler. Fibrin glue was applied to the margin of the pancreas. The operativ e blood loss, duration of operation, and postoperative hospital stay were 1 50 and 250 mL, 150 and 180 minutes, and 7 and 9 days, respectively. The pat hology revealed both lesions to be mucinous cystic neoplasms. The patients recovered and at 6-month follow-up were without complaints and in good heal th. Spleen-preserving pancreatectomy is rapid and associated with minimal m orbidity. This procedure should be considered in the surgical management of cystic neoplasms in the tail of the pancreas.