[Distal pancreatectomy: one technique with several indications]

Distal pancreatectomy (DP) is performed for various pancreatic processes. This procedure has become less frequent since it ceased to be systematically used in oncologic gastric surgery and it is now performed mainly in patients with chronic pancreatitis. We present a series of patients who underwent DP and discuss technical features and surgical indications.

We performed a retrospective study of patients who underwent classical DP with associated splenectomy (CIE: 52.52) in our service from 1998-2003. Fourteen DP were performed during the study period.

The mean age was 52.6 years. Thirty-six percent of the patients were male (5/14). Diagnosis was mucinous cystic tumor of the pancreas (5), neuroendocrine tumor (3), focal chronic pancreatitis (2), pancreatic cancer (2), pancreatic injury due to a sharp instrument wound (1), and pancreatic metastases from renal cancer (1). The most frequently used diagnostic procedure was abdominal computerized axial tomography (13/14). Surgery was elective in 86%. The technique used to close the distal stump was manual suture (29%), mechanical stapling (64%) and suture plus stapling (7%). No statistically significant relationship was observed between closure of the stump and the development of pancreatic fistula. Morbidity was 35% and mortality was 0%. The mean length of hospital stay was 18 days.

DP can be performed without mortality but morbidity is not inconsiderable and is usually associated with the development of pancreatic fistulas. The indications for DP have changed and currently this procedure is performed for several pancreatic processes that are becoming increasingly frequent.