DISTAL PANCREATECTOMY USING A NO-TOUCH ISOLATION TECHNIQUE

Background and Aims: Distal pancreatectomy is the only effective treatment for cancers of the pancreatic body and tail. The recurrence rate after DP has remained high. In an effort to overcome this problem, we developed a no-touch surgical technique for DP. This is a pilot study to see if distal pancreatectomy can be technically done using a no-touch surgical technique without deteriorating the post-operative prognosis. Patients and Methods: From November 2000 through May 2011, 16 pancreatic ductal adenocarcinoma patients have been operated on using a no-touch technique by a single operator. We described the surgical technique, and we reported our preliminary experience. During the procedure, the pancreatic body and tail is neither grasped nor squeezed by the surgeon. And all drainage vessels from the pancreatic body and tail are ligated and divided during the early phase of the operation. Furthermore, for improved dissection of the retroperitoneal tissue (rightward and posterior margins), we use a hanging and clamping maneuver and dissection behind Gerota's fascia. Results: In the current series, the posterior and rightward resection margins were free in all patients, although seven were positive for anterior serosal invasion. The post-operative prognosis was not deteriorated with this technique. Conclusion: No-touch distal pancreatectomy technique may have some theoretical advantages, which merit future investigation in randomized controlled trials.