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Surgical resection of lesions of the body and tail of the pancreas

Timothy R Donahue, MD
Oscar Joe Hines, MD, FACS
Section Editor
Stanley W Ashley, MD
Deputy Editor
Wenliang Chen, MD, PhD


A variety of pancreatic pathologies, malignant and benign, may indicate the need to remove the pancreatic tissue to the left of the superior mesenteric artery and vein (ie, distal pancreas). Distal pancreatectomy, which removes the body and tail of the pancreas, accounts for approximately 25 percent of all pancreatic resections. Distal pancreatectomy was first performed by Billroth in 1884. Less extensive resections can also be performed in the form of central pancreatectomy, which removes part of the body of the pancreas, or enucleation, which limits the resection to the lesion and immediately adjacent parenchyma.

The indications, preoperative evaluation and preparation, and techniques for resecting lesions of the body and the tail of the pancreas will be reviewed here. Resection of the head of the pancreas requires concomitant resection of the duodenum (ie, pancreaticoduodenectomy) and is discussed in detail elsewhere. (See "Surgical resection of lesions of the head of the pancreas".)


The pancreas is a compound exocrine and endocrine gland located in the retroperitoneum at the level of the second lumbar vertebrae. Exocrine pancreatic secretion is composed of enzymes, water, electrolytes and bicarbonate, which are delivered to the duodenum via the pancreatic duct of Wirsung and aid with digestion. Endocrine secretions include insulin, glucagon, and somatostatin from the islets of Langerhans, A cells, and D cells, respectively. Removal of up to 90 percent of the mass of the pancreas can be performed without resulting in diabetes.

The pancreas is divided into five parts including the head, uncinate process, neck, body, and tail (figure 1). The head of the pancreas lies to the right of the superior mesenteric artery. The uncinate process is a variable posterolateral extension of the head that passes behind the retropancreatic vessels and anterior to the inferior vena cava and aorta. The neck is defined as the portion of the gland overlying the superior mesenteric vessels. The body and tail lie to the left of the mesenteric vessels; there is no meaningful anatomic division between the body and tail.

Ductal anatomy — The pancreatic duct, located at the posterior (dorsal) aspect of the gland, joins the common bile duct to drain into the duodenum via the major papilla (ampulla of Vater) (figure 2 and picture 1). The anatomy of these ducts can vary. In 85 percent of individuals, the pancreatic duct and the common bile duct enter the duodenum through a common channel. In 5 percent of patients, both ducts enter the duodenum through the same ampulla but via separate channels. In the remaining 10 percent of patients, each duct enters the duodenum through a separate ampulla [1]. The entry of the common bile duct into the pancreatic tissue posteriorly can also vary (figure 3).

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Literature review current through: Nov 2017. | This topic last updated: Oct 18, 2016.
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  1. MILLBOURN E. On the excretory ducts of the pancreas in man, with special reference to their relations to each other, to the common bile duct and to the duodenum. Acta Anat (Basel) 1950; 9:1.
  2. Goh BK, Tan YM, Chung YF, et al. Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution. Arch Surg 2008; 143:956.
  3. Wade TP, Virgo KS, Johnson FE. Distal pancreatectomy for cancer: results in U.S. Department of Veterans Affairs hospitals, 1987-1991. Pancreas 1995; 11:341.
  4. Brennan MF, Moccia RD, Klimstra D. Management of adenocarcinoma of the body and tail of the pancreas. Ann Surg 1996; 223:506.
  5. Norton JA. Surgery for primary pancreatic neuroendocrine tumors. J Gastrointest Surg 2006; 10:327.
  6. Kazanjian KK, Reber HA, Hines OJ. Resection of pancreatic neuroendocrine tumors: results of 70 cases. Arch Surg 2006; 141:765.
  7. Hung JS, Chang MC, Lee PH, Tien YW. Is surgery indicated for patients with symptomatic nonfunctioning pancreatic neuroendocrine tumor and unresectable hepatic metastases? World J Surg 2007; 31:2392.
  8. Kiely JM, Nakeeb A, Komorowski RA, et al. Cystic pancreatic neoplasms: enucleate or resect? J Gastrointest Surg 2003; 7:890.
  9. Talamini MA, Moesinger R, Yeo CJ, et al. Cystadenomas of the pancreas: is enucleation an adequate operation? Ann Surg 1998; 227:896.
  10. Tanaka M, Fernández-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012; 12:183.
  11. Vege SS, Ziring B, Jain R, et al. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148:819.
  12. Nealon WH, Walser E. Surgical management of complications associated with percutaneous and/or endoscopic management of pseudocyst of the pancreas. Ann Surg 2005; 241:948.
  13. Rattner DW, Fernandez-del Castillo C, Warshaw AL. Pitfalls of distal pancreatectomy for relief of pain in chronic pancreatitis. Am J Surg 1996; 171:142.
  14. Maingot's abdominal operations, Maingot, R, Zinner, M (Eds), Appleton & Lange, Connecticut 1997.
  15. Kondo Y, Friess H, Tempia-Caliera AA, Büchler MW. Duodenum-preserving pancreatic head resection: future standard operation in chronic pancreatitis. Swiss Surg 2000; 6:254.
  16. King J, Kazanjian K, Matsumoto J, et al. Distal pancreatectomy: incidence of postoperative diabetes. J Gastrointest Surg 2008; 12:1548.
  17. Feliciano DV, Mattox KL, Moore EE. Trauma, McGraw-Hill, New York 2008.
  18. Hung JH, Wang SE, Shyr YM, et al. Resection for secondary malignancy of the pancreas. Pancreas 2012; 41:121.
  19. Schwarz L, Sauvanet A, Regenet N, et al. Long-term survival after pancreatic resection for renal cell carcinoma metastasis. Ann Surg Oncol 2014; 21:4007.
  20. Moletta L, Milanetto AC, Vincenzi V, et al. Pancreatic secondary lesions from renal cell carcinoma. World J Surg 2014; 38:3002.
  21. Kubo H, Chijiiwa Y, Akahoshi K, et al. Intraductal papillary-mucinous tumors of the pancreas: differential diagnosis between benign and malignant tumors by endoscopic ultrasonography. Am J Gastroenterol 2001; 96:1429.
  22. Wolf AM, Pucci MJ, Gabale SD, et al. Safety of perioperative aspirin therapy in pancreatic operations. Surgery 2014; 155:39.
  23. Lavu H, Kennedy EP, Mazo R, et al. Preoperative mechanical bowel preparation does not offer a benefit for patients who undergo pancreaticoduodenectomy. Surgery 2010; 148:278.
  24. Bruns H, Rahbari NN, Löffler T, et al. Perioperative management in distal pancreatectomy: results of a survey in 23 European participating centres of the DISPACT trial and a review of literature. Trials 2009; 10:58.
  25. Donald GW, Sunjaya D, Lu X, et al. Perioperative antibiotics for surgical site infection in pancreaticoduodenectomy: does the SCIP-approved regimen provide adequate coverage? Surgery 2013; 154:190.
  26. Fry DE. Surgical site infections and the surgical care improvement project (SCIP): evolution of national quality measures. Surg Infect (Larchmt) 2008; 9:579.
  27. Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines Writers Workgroup, et al. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004; 38:1706.
  28. Chew HK, Wun T, Harvey D, et al. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 2006; 166:458.
  29. Fernández-del Castillo C, Warshaw AL. Laparoscopy for staging in pancreatic carcinoma. Surg Oncol 1993; 2 Suppl 1:25.
  30. del Castillo CF, Warshaw L. Peritoneal metastases in pancreatic carcinoma. Hepatogastroenterology 1993; 40:430.
  31. John TG, Greig JD, Crosbie JL, et al. Superior staging of liver tumors with laparoscopy and laparoscopic ultrasound. Ann Surg 1994; 220:711.
  32. Doucas H, Sutton CD, Zimmerman A, et al. Assessment of pancreatic malignancy with laparoscopy and intraoperative ultrasound. Surg Endosc 2007; 21:1147.
  33. Tomlinson JS, Jain S, Bentrem DJ, et al. Accuracy of staging node-negative pancreas cancer: a potential quality measure. Arch Surg 2007; 142:767.
  34. MALLET-GUY P, VACHON A. [Not Available]. Lyon Chir 1950; 45:125.
  35. Warshaw AL. Conservation of the spleen with distal pancreatectomy. Arch Surg 1998; 123:550.
  36. Warshaw AL. Distal pancreatectomy with preservation of the spleen. J Hepatobiliary Pancreat Sci 2010; 17:808.
  37. Shoup M, Brennan MF, McWhite K, et al. The value of splenic preservation with distal pancreatectomy. Arch Surg 2002; 137:164.
  38. Jean-Philippe Adam, Alexandre Jacquin, Christophe Laurent, et al. Laparoscopic spleen-preserving distal pancreatectomy: splenic vessel preservation compared with the Warshaw technique. JAMA Surg 2013; 148:246.
  39. Aldridge MC, Williamson RC. Distal pancreatectomy with and without splenectomy. Br J Surg 1991; 78:976.
  40. Benoist S, Dugué L, Sauvanet A, et al. Is there a role of preservation of the spleen in distal pancreatectomy? J Am Coll Surg 1999; 188:255.
  41. Tien YW, Liu KL, Hu RH, et al. Risk of varices bleeding after spleen-preserving distal pancreatectomy with excision of splenic artery and vein. Ann Surg Oncol 2010; 17:2193.
  42. Zhou ZQ, Kim SC, Song KB, et al. Laparoscopic spleen-preserving distal pancreatectomy: comparative study of spleen preservation with splenic vessel resection and splenic vessel preservation. World J Surg 2014; 38:2973.
  43. He Z, Qian D, Hua J, et al. Clinical comparison of distal pancreatectomy with or without splenectomy: a meta-analysis. PLoS One 2014; 9:e91593.
  44. Knaebel HP, Diener MK, Wente MN, et al. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 2005; 92:539.
  45. Jensen EH, Portschy PR, Chowaniec J, Teng M. Meta-analysis of bioabsorbable staple line reinforcement and risk of fistula following pancreatic resection. J Gastrointest Surg 2013; 17:267.
  46. Zhou W, Lv R, Wang X, et al. Stapler vs suture closure of pancreatic remnant after distal pancreatectomy: a meta-analysis. Am J Surg 2010; 200:529.
  47. Probst P, Hüttner FJ, Klaiber U, et al. Stapler versus scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy. Cochrane Database Syst Rev 2015; :CD008688.
  48. Zhang H, Zhu F, Shen M, et al. Systematic review and meta-analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy. Br J Surg 2015; 102:4.
  49. Diener MK, Seiler CM, Rossion I, et al. Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet 2011; 377:1514.
  50. Kawai M, Tani M, Okada K, et al. Stump closure of a thick pancreas using stapler closure increases pancreatic fistula after distal pancreatectomy. Am J Surg 2013; 206:352.
  51. Yamamoto M, Hayashi MS, Nguyen NT, et al. Use of Seamguard to prevent pancreatic leak following distal pancreatectomy. Arch Surg 2009; 144:894.
  52. Thaker RI, Matthews BD, Linehan DC, et al. Absorbable mesh reinforcement of a stapled pancreatic transection line reduces the leak rate with distal pancreatectomy. J Gastrointest Surg 2007; 11:59.
  53. Hamilton NA, Porembka MR, Johnston FM, et al. Mesh reinforcement of pancreatic transection decreases incidence of pancreatic occlusion failure for left pancreatectomy: a single-blinded, randomized controlled trial. Ann Surg 2012; 255:1037.
  54. Hawkins WG. To mesh or not to mesh, that is the question: comment on "Use of Seamguard to prevent pancreatic leak following distal pancreatectomy". Arch Surg 2009; 144:899.
  55. Carter TI, Fong ZV, Hyslop T, et al. A dual-institution randomized controlled trial of remnant closure after distal pancreatectomy: does the addition of a falciform patch and fibrin glue improve outcomes? J Gastrointest Surg 2013; 17:102.
  56. Iannitti DA, Coburn NG, Somberg J, et al. Use of the round ligament of the liver to decrease pancreatic fistulas: a novel technique. J Am Coll Surg 2006; 203:857.
  57. Hassenpflug M, Hinz U, Strobel O, et al. Teres Ligament Patch Reduces Relevant Morbidity After Distal Pancreatectomy (the DISCOVER Randomized Controlled Trial). Ann Surg 2016; 264:723.
  58. Mita K, Ito H, Fukumoto M, et al. A fibrin adhesive sealing method for the prevention of pancreatic fistula following distal pancreatectomy. Hepatogastroenterology 2011; 58:604.
  59. Suzuki Y, Kuroda Y, Morita A, et al. Fibrin glue sealing for the prevention of pancreatic fistulas following distal pancreatectomy. Arch Surg 1995; 130:952.
  60. Suc B, Msika S, Fingerhut A, et al. Temporary fibrin glue occlusion of the main pancreatic duct in the prevention of intra-abdominal complications after pancreatic resection: prospective randomized trial. Ann Surg 2003; 237:57.
  61. Kaminsky PM, Mezhir JJ. Intraperitoneal drainage after pancreatic resection: a review of the evidence. J Surg Res 2013; 184:925.
  62. Pannegeon V, Pessaux P, Sauvanet A, et al. Pancreatic fistula after distal pancreatectomy: predictive risk factors and value of conservative treatment. Arch Surg 2006; 141:1071.
  63. Adham M, Chopin-Laly X, Lepilliez V, et al. Pancreatic resection: drain or no drain? Surgery 2013; 154:1069.
  64. Petrowsky H, Demartines N, Rousson V, Clavien PA. Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 2004; 240:1074.
  65. Heslin MJ, Harrison LE, Brooks AD, et al. Is intra-abdominal drainage necessary after pancreaticoduodenectomy? J Gastrointest Surg 1998; 2:373.
  66. Conlon KC, Labow D, Leung D, et al. Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 2001; 234:487.
  67. Ammori BJ, Baghdadi S. Minimally invasive pancreatic surgery: the new frontier? Curr Gastroenterol Rep 2006; 8:132.
  68. Ammori BJ. Pancreatic surgery in the laparoscopic era. JOP 2003; 4:187.
  69. Mabrut JY, Fernandez-Cruz L, Azagra JS, et al. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 2005; 137:597.
  70. Tran Cao HS, Lopez N, Chang DC, et al. Improved perioperative outcomes with minimally invasive distal pancreatectomy: results from a population-based analysis. JAMA Surg 2014; 149:237.
  71. Choi SH, Kang CM, Lee WJ, Chi HS. Robot-assisted spleen-preserving laparoscopic distal pancreatectomy. Ann Surg Oncol 2011; 18:3623.
  72. Daouadi M, Zureikat AH, Zenati MS, et al. Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg 2013; 257:128.
  73. Pericleous S, Middleton N, McKay SC, et al. Systematic review and meta-analysis of case-matched studies comparing open and laparoscopic distal pancreatectomy: is it a safe procedure? Pancreas 2012; 41:993.
  74. Venkat R, Edil BH, Schulick RD, et al. Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg 2012; 255:1048.
  75. Jin T, Altaf K, Xiong JJ, et al. A systematic review and meta-analysis of studies comparing laparoscopic and open distal pancreatectomy. HPB (Oxford) 2012; 14:711.
  76. Sui CJ, Li B, Yang JM, et al. Laparoscopic versus open distal pancreatectomy: a meta-analysis. Asian J Surg 2012; 35:1.
  77. Xie K, Zhu YP, Xu XW, et al. Laparoscopic distal pancreatectomy is as safe and feasible as open procedure: a meta-analysis. World J Gastroenterol 2012; 18:1959.
  78. Jusoh AC, Ammori BJ. Laparoscopic versus open distal pancreatectomy: a systematic review of comparative studies. Surg Endosc 2012; 26:904.
  79. Nigri GR, Rosman AS, Petrucciani N, et al. Metaanalysis of trials comparing minimally invasive and open distal pancreatectomies. Surg Endosc 2011; 25:1642.
  80. Underwood RA, Soper NJ. Current status of laparoscopic surgery of the pancreas. J Hepatobiliary Pancreat Surg 1999; 6:154.
  81. Pierce RA, Spitler JA, Hawkins WG, et al. Outcomes analysis of laparoscopic resection of pancreatic neoplasms. Surg Endosc 2007; 21:579.
  82. Mehrabi A, Hafezi M, Arvin J, et al. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it's time to randomize. Surgery 2015; 157:45.
  83. Lee SY, Allen PJ, Sadot E, et al. Distal pancreatectomy: a single institution's experience in open, laparoscopic, and robotic approaches. J Am Coll Surg 2015; 220:18.
  84. Cho CS, Kooby DA, Schmidt CM, et al. Laparoscopic versus open left pancreatectomy: can preoperative factors indicate the safer technique? Ann Surg 2011; 253:975.
  85. de Rooij T, Jilesen AP, Boerma D, et al. A nationwide comparison of laparoscopic and open distal pancreatectomy for benign and malignant disease. J Am Coll Surg 2015; 220:263.
  86. Palanivelu C, Shetty R, Jani K, et al. Laparoscopic distal pancreatectomy: results of a prospective non-randomized study from a tertiary center. Surg Endosc 2007; 21:373.
  87. Root J, Nguyen N, Jones B, et al. Laparoscopic distal pancreatic resection. Am Surg 2005; 71:744.
  88. Velanovich V. Case-control comparison of laparoscopic versus open distal pancreatectomy. J Gastrointest Surg 2006; 10:95.
  89. Kneuertz PJ, Patel SH, Chu CK, et al. Laparoscopic distal pancreatectomy: trends and lessons learned through an 11-year experience. J Am Coll Surg 2012; 215:167.
  90. Marangos IP, Buanes T, Røsok BI, et al. Laparoscopic resection of exocrine carcinoma in central and distal pancreas results in a high rate of radical resections and long postoperative survival. Surgery 2012; 151:717.
  91. Riviere D, Gurusamy KS, Kooby DA, et al. Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Cochrane Database Syst Rev 2016; 4:CD011391.
  92. Fernández-Cruz L, Cosa R, Blanco L, et al. Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J Gastrointest Surg 2007; 11:1607.
  93. Yao D, Wu S, Tian Y, et al. Transumbilical single-incision laparoscopic distal pancreatectomy: primary experience and review of the English literature. World J Surg 2014; 38:1196.
  94. Dokmak S. Medial or lateral approach for laparoscopic splenic vessel-preserving distal pancreatectomy? Surgery 2012; 152:143.
  95. Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery 2003; 133:521.
  96. Park HJ, You DD, Choi DW, et al. Role of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas. World J Surg 2014; 38:186.
  97. Mitchem JB, Hamilton N, Gao F, et al. Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure. J Am Coll Surg 2012; 214:46.
  98. Strasberg SM, Linehan DC, Hawkins WG. Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg 2007; 204:244.
  99. Rosso E, Langella S, Addeo P, et al. A safe technique for radical antegrade modular pancreatosplenectomy with venous resection for pancreatic cancer. J Am Coll Surg 2013; 217:e35.
  100. Goudard Y, Gaujoux S, Dokmak S, et al. Reappraisal of central pancreatectomy a 12-year single-center experience. JAMA Surg 2014; 149:356.
  101. Iacono C, Verlato G, Ruzzenente A, et al. Systematic review of central pancreatectomy and meta-analysis of central versus distal pancreatectomy. Br J Surg 2013; 100:873.
  102. Xu SB, Zhu YP, Zhou W, et al. Patients get more long-term benefit from central pancreatectomy than distal resection: a meta-analysis. Eur J Surg Oncol 2013; 39:567.
  103. Goldstein MJ, Toman J, Chabot JA. Pancreaticogastrostomy: a novel application after central pancreatectomy. J Am Coll Surg 2004; 198:871.
  104. Wente MN, Shrikhande SV, Müller MW, et al. Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis. Am J Surg 2007; 193:171.
  105. Rault A, SaCunha A, Klopfenstein D, et al. Pancreaticojejunal anastomosis is preferable to pancreaticogastrostomy after pancreaticoduodenectomy for longterm outcomes of pancreatic exocrine function. J Am Coll Surg 2005; 201:239.
  106. Connor S, Alexakis N, Garden OJ, et al. Meta-analysis of the value of somatostatin and its analogues in reducing complications associated with pancreatic surgery. Br J Surg 2005; 92:1059.
  107. Zeng Q, Zhang Q, Han S, et al. Efficacy of somatostatin and its analogues in prevention of postoperative complications after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials. Pancreas 2008; 36:18.
  108. Hesse UJ, DeDecker C, Houtmeyers P, et al. Prospectively randomized trial using perioperative low-dose octreotide to prevent organ-related and general complications after pancreatic surgery and pancreatico-jejunostomy. World J Surg 2005; 29:1325.
  109. Alghamdi AA, Jawas AM, Hart RS. Use of octreotide for the prevention of pancreatic fistula after elective pancreatic surgery: a systematic review and meta-analysis. Can J Surg 2007; 50:459.
  110. Shan YS, Sy ED, Tsai ML, et al. Effects of somatostatin prophylaxis after pylorus-preserving pancreaticoduodenectomy: increased delayed gastric emptying and reduced plasma motilin. World J Surg 2005; 29:1319.
  111. Ramos-De la Medina A, Sarr MG. Somatostatin analogues in the prevention of pancreas-related complications after pancreatic resection. J Hepatobiliary Pancreat Surg 2006; 13:190.
  112. Suc B, Msika S, Piccinini M, et al. Octreotide in the prevention of intra-abdominal complications following elective pancreatic resection: a prospective, multicenter randomized controlled trial. Arch Surg 2004; 139:288.
  113. Sarr MG, Pancreatic Surgery Group. The potent somatostatin analogue vapreotide does not decrease pancreas-specific complications after elective pancreatectomy: a prospective, multicenter, double-blinded, randomized, placebo-controlled trial. J Am Coll Surg 2003; 196:556.
  114. Gurusamy KS, Koti R, Fusai G, Davidson BR. Somatostatin analogues for pancreatic surgery. Cochrane Database Syst Rev 2013; :CD008370.
  115. Bassi C, Butturini G, Molinari E, et al. Pancreatic fistula rate after pancreatic resection. The importance of definitions. Dig Surg 2004; 21:54.
  116. Allen PJ, Gönen M, Brennan MF, et al. Pasireotide for postoperative pancreatic fistula. N Engl J Med 2014; 370:2014.
  117. Paye F, Micelli Lupinacci R, Bachellier P, et al. Distal pancreatectomy for pancreatic carcinoma in the era of multimodal treatment. Br J Surg 2015; 102:229.
  118. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet 1996; 347:995.
  119. Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002; 346:1128.
  120. Kleeff J, Diener MK, Z'graggen K, et al. Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 2007; 245:573.
  121. Rodríguez JR, Germes SS, Pandharipande PV, et al. Implications and cost of pancreatic leak following distal pancreatic resection. Arch Surg 2006; 141:361.
  122. Lillemoe KD, Kaushal S, Cameron JL, et al. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 1999; 229:693.
  123. Dalla Bona E, Beltrame V, Liessi F, Sperti C. Fatal pneumococcal sepsis eleven years after distal pancreatectomy with splenectomy for pancreatic cancer. JOP 2012; 13:693.
  124. Butturini G, Daskalaki D, Molinari E, et al. Pancreatic fistula: definition and current problems. J Hepatobiliary Pancreat Surg 2008; 15:247.
  125. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005; 138:8.
  126. Diener MK, Knaebel HP, Witte ST, et al. DISPACT trial: a randomized controlled trial to compare two different surgical techniques of DIStal PAnCreaTectomy - study rationale and design. Clin Trials 2008; 5:534.
  127. Ban D, Shimada K, Konishi M, et al. Stapler and nonstapler closure of the pancreatic remnant after distal pancreatectomy: multicenter retrospective analysis of 388 patients. World J Surg 2012; 36:1866.
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