Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2015; 21(11): 3166-3169
Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3166
Perioperative management of distal pancreatectomy
Yasuhiro Fujino
Yasuhiro Fujino, Department of Surgery, Hyogo Cancer Center, Akashi 673-8558, Japan
Author contributions: Fujino Y solely contributed to this paper.
Conflict-of-interest: The author declares no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yasuhiro Fujino, MD, PhD, Department of Surgery, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi 673-8558, Japan. yasu120@hp.pref.hyogo.jp
Telephone: +81-78-9291151 Fax: +81-78-9292380
Received: November 25, 2014
Peer-review started: November 26, 2014
First decision: December 26, 2014
Revised: January 19, 2015
Accepted: February 5, 2015
Article in press: February 5, 2015
Published online: March 21, 2015

Recent advances in surgical techniques and perioperative management have markedly reduced operative morbidity after distal pancreatectomy (DP). However, some questions remain regarding the protocol for the perioperative management of DP, in particular, with regard to the development of pancreatic fistula (PF). A review of DP was therefore conducted in order to standardize the management of patients for a favorable outcome. Overall, operative technique and perioperative management emerged as two critical factors contributing to favorable outcome in DP patients. As for the operative method, surgical and closure techniques exhibited differences in outcome. Laparoscopic DP generally yields more favorable perioperative outcomes compared to open DP, and is applicable for benign tumors and some ductal carcinomas of the pancreas. Robotic DP is also available for safe pancreatic surgery. En bloc celiac axis resection offers a high R0 resection rate and potentially allows for some local control in the case of advanced pancreatic cancer. Following resection, staple closure was not found to reduce the rate of PF when compared to hand-sewn closure. In addition, ultrasonic dissection devices, fibrin glue sealing, and staple closure with mesh reinforcement were shown to significantly reduce PF, although there was some bias in these studies. In perioperative management, both preoperative and postoperative treatment affected outcome. First, preoperative endoscopic pancreatic stenting may be an effective prophylactic measure against fistula development following DP in selected patients. Second, in postoperative management, a multifactorial approach including prophylactic antibiotics improved high surgical site infection rates following complex hepato-pancreato-biliary surgery. Furthermore, although conflicting results have been reported, somatostatin analogues should be administered selectively to patients considered to have a high risk for PF. Finally, careful drain management also facilitates a favorable outcome in patients with PF after DP. The results of the review indicate that laparoscopic DP coupled with perioperative management influences outcome in DP patients.

Keywords: Distal pancreatectomy, Pancreatic fistula, Perioperative management

Core tip: Perioperative management of distal pancreatectomy has been reviewed in order to standardize management for a favorable outcome in these patients.