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Distal pancreatectomy removes the body and tail of the pancreas, the part to the left of the main vessels, usually with the spleen when the cause is cancer. The bile duct and duodenum are left alone, so there is no Whipple-type reconstruction; keyhole and robotic versions recover faster and, in a randomised trial, removed pancreatic cancer as completely as open surgery.
Tumours of the pancreatic body and tail present later than head tumours because they do not block the bile duct, so fewer are resectable; when they are, the operation is a distal pancreatectomy, with splenectomy and removal of the splenic vessels and regional nodes for cancer (the radical antegrade modular pancreatosplenectomy technique clears the nodes and the plane behind the gland), and spleen preservation for benign or low-grade tumours such as solid pseudopapillary neoplasm and small mucinous cystic neoplasms. The pancreatic stump is closed or stapled and the commonest complication is a pancreatic fistula; splenectomy carries a lifelong infection risk that vaccination and, in some centres, antibiotics address. Two randomised trials define the minimally invasive approach. LEOPARD (14 Dutch centres, 108 patients with left-sided tumours confined to the pancreas) found time to functional recovery of 4 days after minimally invasive against 6 days after open surgery, with less delayed gastric emptying and better quality of life at no extra cost, though the overall complication rate was unchanged (de Rooij 2019). DIPLOMA (35 centres in 12 countries, 258 patients with resectable pancreatic cancer, patients and pathologists blinded) found an R0 resection (1 mm or more) in 73 percent after minimally invasive and 69 percent after open distal pancreatectomy, within the non-inferiority margin, with comparable lymph node yield (Korrel 2023). NICE NG85 recommends standard rather than extended lymphadenectomy for head resections (1.8.4) and enzyme replacement before and after resection (1.6.2); after distal pancreatectomy diabetes and exocrine insufficiency depend on how much gland remains. Adjuvant chemotherapy follows as for any resected pancreatic ductal adenocarcinoma.
Showing the technology this term belongs to: Robotic & minimally invasive surgery.
Shares Surgical morbidity and postoperative complications, R0 and R1 margins in pancreatic cancer: the 1 mm rule and standardised specimen reporting, Whipple procedure (pancreaticoduodenectomy), Robotic & minimally invasive surgery and the tags gi, pancreatic.
Shares Pancreatic enzyme replacement therapy (PERT, pancreatin, Creon) for pancreatic exocrine insufficiency: why and how to take it, Whipple procedure (pancreaticoduodenectomy), Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares Pancreatic enzyme replacement therapy (PERT, pancreatin, Creon) for pancreatic exocrine insufficiency: why and how to take it, Whipple procedure (pancreaticoduodenectomy), Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares Colloid (mucinous non-cystic) carcinoma of the pancreas, Mucinous cystic neoplasm of the pancreas with associated invasive carcinoma (MCN-associated carcinoma), Invasive carcinoma arising in an intraductal papillary mucinous neoplasm (IPMN-associated carcinoma), Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares R0 and R1 margins in pancreatic cancer: the 1 mm rule and standardised specimen reporting, Resectable pancreatic ductal adenocarcinoma, Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares Invasive carcinoma arising in an intraductal papillary mucinous neoplasm (IPMN-associated carcinoma), Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares Resectable pancreatic ductal adenocarcinoma, Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.
Shares Resectable pancreatic ductal adenocarcinoma, Pancreatic ductal adenocarcinoma and the tags gi, pancreatic.