Distal pancreatectomy or pancreatic tail resection is the resection of pancreatic tissue to the left of the superior mesenteric artery and vein. This procedure was first performed by Billroth in 1884 and accounts for approximately one quarter of all pancreatic resections.
Please note that technical details such as suture choice presented below reflect the author's preferences and are not meant to imply that these are requirements for successful surgical outcomes.
Distal pancreatectomy is performed primarily for malignant and premalignant diseases including pancreatic adenocarcinoma, pancreatic cystic neoplasms, and neuroendocrine tumors. Benign indications for distal pancreatectomy include chronic pancreatitis, pancreatic pseudocysts, and trauma with main pancreatic ductal disruption. In a series of 232 distal pancreatectomies where 164 were performed for pancreas-specific disease, 84 percent were for malignant or premalignant disease, while only 16 percent were for benign diseases .
Adenocarcinoma in body and tail of the pancreas — Patients with adenocarcinoma in the body and tail of the gland have historically presented with more advanced disease because lesions in this area can become quite large before they become symptomatic from local invasion and metastatic disease [2-4]. As a result of this later presentation, body and tail lesions are less likely to be resectable and have been associated with shorter survival than pancreatic head cancers, although the biology of the tumors is the same. However, improved high resolution pancreatic-protocol computed tomography (CT) and magnetic resonance (MR) imaging techniques have led to the more frequent recognition of body and tail lesions at earlier stages. Thus, distal pancreatectomy is becoming a more frequently used procedure.
Even if preoperative imaging shows potentially resectable disease, many surgeons believe that laparoscopic exploration should precede attempted resection, since a significant proportion will have occult peritoneal metastases [5,6]. Staging laparoscopy has been shown to alter the management approach in up to 44 percent of patients . Splenectomy should be anticipated to ensure clear margins and adequate lymph node sampling . (See "Clinical manifestations, diagnosis, and staging of exocrine pancreatic cancer", section on 'Diagnostic approach'.)