Distal pancreatectomy: Indications and outcomes in 235 patients

Keith D. Lillemoe, Sunjay Kaushal, John L. Cameron, Taylor A. Sohn, Henry A. Pitt, Charles J. Yeo

Research output: Contribution to journalArticle

468 Citations (Scopus)

Abstract

Objective: Distal pancreatectomy is performed for a variety of benign and malignant conditions. In recent years, significant improvements in perioperative results have been observed at high-volume centers after pancreaticoduodenectomy. Little data, however, are available concerning the current indications and outcomes after distal pancreatectomy. This single- institution experience reviews the recent indications, complications, and outcomes after distal pancreatectomy. Methods: A retrospective analysis was performed of the hospital records of all patients undergoing distal pancreatectomy between January 1994 and December 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 included chronic pancreatitis (24%), benign pancreatic cystadenoma (22%), pancreatic adenocarcinoma (18%), neuroendocrine tumor (14%), pancreatic pseudocyst (6%), cystadenocarcinoma (3%), and miscellaneous (13%). The level of resection was at or to the left of the superior mesenteric vein in 96% of patients. A splenectomy was performed in 84% and a cholecystectomy in 15% of patients. 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 surgery for a perioperative mortality rate of 0.9%. The overall postoperative complication rate was 31%; the most common complications were new-onset insulin-dependent diabetes (8%), pancreatic fistula (5%), intraabdominal abscess (4%), small bowel obstruction (4%), and postoperative hemorrhage (4%). Fourteen patients (6%) required a second surgical procedure; the most common 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%), operative time (4.6 vs. 5.1 hours), and intraoperative blood loss (500 vs. 350 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 experience with distal pancreatectomy. These data demonstrate that elective distal pancreatectomy is associated with a mortality rate of <1%. These results demonstrate that, as with pancreaticoduodenectomy, distal pancreatectomy can be performed with minimal perioperative mortality and acceptable morbidity.

Original languageEnglish (US)
Pages (from-to)693-700
Number of pages8
JournalAnnals of Surgery
Volume229
Issue number5
DOIs
StatePublished - May 1999
Externally publishedYes

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Pancreatectomy
Pancreaticoduodenectomy
Splenectomy
Operative Time
Mortality
Length of Stay
Cystadenocarcinoma
Cystadenoma
Pancreatic Fistula
Pancreatic Pseudocyst
Mesenteric Veins
Postoperative Hemorrhage
Neuroendocrine Tumors
Hospital Records
Chronic Pancreatitis
Cholecystectomy
Ambulatory Surgical Procedures
Abscess
Adenocarcinoma
Erythrocytes

ASJC Scopus subject areas

  • Surgery

Cite this

Lillemoe, K. D., Kaushal, S., Cameron, J. L., Sohn, T. A., Pitt, H. A., & Yeo, C. J. (1999). Distal pancreatectomy: Indications and outcomes in 235 patients. Annals of Surgery, 229(5), 693-700. https://doi.org/10.1097/00000658-199905000-00012

Distal pancreatectomy : Indications and outcomes in 235 patients. / Lillemoe, Keith D.; Kaushal, Sunjay; Cameron, John L.; Sohn, Taylor A.; Pitt, Henry A.; Yeo, Charles J.

In: Annals of Surgery, Vol. 229, No. 5, 05.1999, p. 693-700.

Research output: Contribution to journalArticle

Lillemoe, KD, Kaushal, S, Cameron, JL, Sohn, TA, Pitt, HA & Yeo, CJ 1999, 'Distal pancreatectomy: Indications and outcomes in 235 patients', Annals of Surgery, vol. 229, no. 5, pp. 693-700. https://doi.org/10.1097/00000658-199905000-00012
Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: Indications and outcomes in 235 patients. Annals of Surgery. 1999 May;229(5):693-700. https://doi.org/10.1097/00000658-199905000-00012
Lillemoe, Keith D. ; Kaushal, Sunjay ; Cameron, John L. ; Sohn, Taylor A. ; Pitt, Henry A. ; Yeo, Charles J. / Distal pancreatectomy : Indications and outcomes in 235 patients. In: Annals of Surgery. 1999 ; Vol. 229, No. 5. pp. 693-700.
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abstract = "Objective: Distal pancreatectomy is performed for a variety of benign and malignant conditions. In recent years, significant improvements in perioperative results have been observed at high-volume centers after pancreaticoduodenectomy. Little data, however, are available concerning the current indications and outcomes after distal pancreatectomy. This single- institution experience reviews the recent indications, complications, and outcomes after distal pancreatectomy. Methods: A retrospective analysis was performed of the hospital records of all patients undergoing distal pancreatectomy between January 1994 and December 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 included chronic pancreatitis (24{\%}), benign pancreatic cystadenoma (22{\%}), pancreatic adenocarcinoma (18{\%}), neuroendocrine tumor (14{\%}), pancreatic pseudocyst (6{\%}), cystadenocarcinoma (3{\%}), and miscellaneous (13{\%}). The level of resection was at or to the left of the superior mesenteric vein in 96{\%} of patients. A splenectomy was performed in 84{\%} and a cholecystectomy in 15{\%} of patients. 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 surgery for a perioperative mortality rate of 0.9{\%}. The overall postoperative complication rate was 31{\%}; the most common complications were new-onset insulin-dependent diabetes (8{\%}), pancreatic fistula (5{\%}), intraabdominal abscess (4{\%}), small bowel obstruction (4{\%}), and postoperative hemorrhage (4{\%}). Fourteen patients (6{\%}) required a second surgical procedure; the most common 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{\%}), operative time (4.6 vs. 5.1 hours), and intraoperative blood loss (500 vs. 350 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 experience with distal pancreatectomy. These data demonstrate that elective distal pancreatectomy is associated with a mortality rate of <1{\%}. These results demonstrate that, as with pancreaticoduodenectomy, distal pancreatectomy can be performed with minimal perioperative mortality and acceptable morbidity.",
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AU - Kaushal, Sunjay

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AU - Pitt, Henry A.

AU - Yeo, Charles J.

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N2 - Objective: Distal pancreatectomy is performed for a variety of benign and malignant conditions. In recent years, significant improvements in perioperative results have been observed at high-volume centers after pancreaticoduodenectomy. Little data, however, are available concerning the current indications and outcomes after distal pancreatectomy. This single- institution experience reviews the recent indications, complications, and outcomes after distal pancreatectomy. Methods: A retrospective analysis was performed of the hospital records of all patients undergoing distal pancreatectomy between January 1994 and December 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 included chronic pancreatitis (24%), benign pancreatic cystadenoma (22%), pancreatic adenocarcinoma (18%), neuroendocrine tumor (14%), pancreatic pseudocyst (6%), cystadenocarcinoma (3%), and miscellaneous (13%). The level of resection was at or to the left of the superior mesenteric vein in 96% of patients. A splenectomy was performed in 84% and a cholecystectomy in 15% of patients. 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 surgery for a perioperative mortality rate of 0.9%. The overall postoperative complication rate was 31%; the most common complications were new-onset insulin-dependent diabetes (8%), pancreatic fistula (5%), intraabdominal abscess (4%), small bowel obstruction (4%), and postoperative hemorrhage (4%). Fourteen patients (6%) required a second surgical procedure; the most common 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%), operative time (4.6 vs. 5.1 hours), and intraoperative blood loss (500 vs. 350 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 experience with distal pancreatectomy. These data demonstrate that elective distal pancreatectomy is associated with a mortality rate of <1%. These results demonstrate that, as with pancreaticoduodenectomy, distal pancreatectomy can be performed with minimal perioperative mortality and acceptable morbidity.

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