No significant superiority of one variant of PD over another has been convincingly demonstrated. Surgeon’s experience with the specific variant of PD appeared to be the determining factor in achieving optimal surgical outcome. Distal pancreatectomy Distal pancreatectomy is the standard procedure for cancer of the body or tail of pancreas. It entails the resection of distal portion of pancreas extending from the left of the superior mesenteric vein / portal vein axis to the tail with en bloc resection of surrounding lymphatic tissue.

Spleen is conventionally removed with the procedure. Spleen-sparing distal pancreatectomy (Warshaw operation) can be performed Inhibitors,research,lifescience,medical safely without increase in complication rate, operative time or in-hospital stay (45). While cancer of the body and tail tends to present at an advanced stage due to the Inhibitors,research,lifescience,medical lack of early symptoms and tends not to be amenable to complete resection on presentation, there is no survival difference

when compared with cancer of the head Inhibitors,research,lifescience,medical of pancreas stage by stage (46),(47). Laparoscopic pancreatic resection With the publication of COST trial, minimally invasive surgical approach has been evaluated in increasing frequency for cancer resection (48). For the surgical management of pancreatic neoplasm, laparoscopic distal pancreatectomy (LDP) is rapidly becoming the surgical procedure of choice in place of open distal Inhibitors,research,lifescience,medical pancreatectomy (ODP) for tumor of the body/tail of pancreas. While several groups have published their results with LDP, the majority of the publication did not specifically address the oncologic outcome following LDP for pancreatic cancer (49)-(59). Overall, when compared with ODP, LDP is associated with a longer operative time,

less blood loss, and shorter length of stay. Conversion rate from laparoscopic approach to open varies between 0 to 30%. In their institutional experience, Baker et al noted a lower number of lymph nodes harvested in 27 LDP patients (mean=5) compared with 85 ODP patients (mean=9) Inhibitors,research,lifescience,medical (57). Kooby et al performed a matched analysis of 23 LDP patients with 189 about ODP patients from a database with pooled data from 9 c-Met inhibitor academic centers (58). There was no difference in positive margin rates, number of lymph nodes examined, or overall survival in patients with pancreatic cancer. Jayaraman et al reviewed their results of 343 distal pancreatectomies over a 7-year study period at Memorial Sloan-Kettering Cancer Center : 107 were attempted laparoscopically and 236 ODP (59). The conversion rate was 30%. Similar complication rates were observed in both groups. They also observed significantly less blood loss, longer operative times, and shorter hospital stays in favor of LDP group. The number of lymph nodes examined (LDP = 7 vs. ODP = 7) and margin positivity (LDP = 3% vs ODP = 4%) were similar between both groups.