Adenocarcinoma of the pancreas that originates to the left of the portal ve
in, i.e. in the body or tail of the pancreas, is seen in approximately one
third of all cases with exocrine pancreatic cancer. Except for symptoms of
pain and weight loss, these patients usually appear normal upon physical ex
amination. In 5-10% of cases, the tumor is resectable by standard surgical
procedures. Unresectability is due to local spread (30-40%) or distant meta
stases (50-65%). The technique of distal pancreatic resection was outlined
by Mayo in 1913. The intimate relationship of the splenic artery and vein t
o the body of the pancreas makes en bloc mobilization of the spleen and pan
creatic tail a safe option; the splenic artery and vein being ligated near
their origin and termination. Although the spleen can frequently be preserv
ed when performing a distal pancreatectomy for benign disease, splenic arte
ry preservation is hazardous for oncologic radicality when resection is per
formed for cancer. Therefore, splenectomy is routine in distal pancreatecto
my - in Mayo's and all subsequent descriptions - with the splenic artery be
ing ligated early in the procedure. Recent reports from specialized centers
indicate that the procedure is associated with a decrease in mortality rat
e, often zero or less than a few percent.