Technical aspects of left-sided pancreatic resection for cancer

Adenocarcinoma of the pancreas that originates to the left of the portal vein, 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 examination. In 5-10% of cases, the tumor is resectable by standard surgical procedures. Unresectability is due to local spread (30-40%) or distant metastases (50-65%). The technique of distal pancreatic resection was outlined by Mayo in 1913. The intimate relationship of the splenic artery and vein to the body of the pancreas makes en bloc mobilization of the spleen and pancreatic tail a safe option; the splenic artery and vein being ligated near their origin and termination. Although the spleen can frequently be preserved when performing a distal pancreatectomy for benign disease, splenic artery preservation is hazardous for oncologic radicality when resection is performed for cancer. Therefore, splenectomy is routine in distal pancreatectomy - in Mayo's and all subsequent descriptions - with the splenic artery being ligated early in the procedure. Recent reports from specialized centers indicate that the procedure is associated with a decrease in mortality rate, often zero or less than a few percent.