Systemic inflammatory response syndrome after hand-assisted laparoscopic distal pancreatectomy

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Abstract
Although the clinical benefits of hand-assisted laparoscopic surgery have been shown in several procedures including colorectal resection, splenectomy and gastrectomy, efficacy and invasiveness in pancreatic surgery have not been well investigated. We assessed the clinical benefits and invasiveness of hand-assisted laparoscopic distal pancreatectomy (HALS-DP) in relation to the occurrence of post-operative systemic inflammatory response syndrome (SIRS). Subjects comprised 8 patients underwent HALS-DP (with splenectomy, n= 7; without splenectomy, n= 1) for benign or low malignant pancreatic lesions between March 2004 and December 2005. Indications for HALS-DP consisted of mucinous cystadenoma (n= 4), endocrine tumors (n= 2), serous cystadenoma (n= 1) and pancreatic pseudocyst (n= 1). Controls comprised 9 patients who underwent conventional open distal pancreatectomy (Open-DP) for benign or low malignant lesions of the pancreas in the same period. No significant differences were identified between HALS-DP and Open-DP in operation time. However, intra-operative blood loss, CRP on post-operative day (POD) 1 [5.5 mg/dl (1.8–8.1) vs. 9.7 mg/dl (5.9–12.1); p = .006] and POD 3 [8.5 mg/dl (1.7–11.1) vs. 17.7 mg/dl (10.7–21.5); p = .003], occurrence of post-operative SIRS (13% vs. 67%; p < .05, one-sided), duration of SIRS [0 day (0–1) vs. 1 day (0–4); p = .02] and post-operative hospital stay were significantly lower in HALS-DP than in Open-DP. Furthermore, no pancreatic fistula was seen with HALS-DP, as compared to 2 (22%) with Open-DP. HALS-DP is safer and less invasive than Open-DP for benign or low malignant pancreatic tumors.