Radical antegrade modular pancreatosplenectomy.

Abstract

Retrograde distal pancreatectomy with splenectomy is the standard procedure for cancers of the body and tail of the pancreas. However, this procedure has limitations in terms of the posterior extent of resection and the ability to achieve a complete N1 node resection. A new antegrade procedure has been developed that provides improved visibility, removes N1 nodes, and permits adjustment of the depth of the posterior extent of resection coupled with early rather than late control of the vasculature. Ten patients, 6 with adenocarcinomas of the body of the pancreas, have undergone the procedure since 1999. Nine of 10 patients had negative resection margins, and the median node count in patients who did not receive neoadjuvant radiation was 9 nodes. Three patients had complications develop; no postoperative deaths occurred. Early results with the procedure are encouraging.