Left-sided pancreatic incidentalomas treated with laparoscopic approach: a report of 20 cases

Abstract

Background: The diffusion of cross-sectional imaging has recently permitted the detection of an increasing number of incidentalomas localized in the distal pancreas. Currently, there are no studies in the literature exploring the laparoscopic approach as treatment for left-sided pancreatic incidentalomas.

Methods and results: We report a series of 20 incidentalomas localized in the body and tail of the pancreas treated with laparoscopic surgery over the period 2010-2014. The incidental masses of our series included a great variety of histotypes and a relevant proportion of malignant lesions. In two cases, the laparoscopic procedures were converted to open surgery. No postoperative death was observed. The postoperative pancreatic fistula rate was 20 %, and the new-onset diabetes rate was 25 %.

Conclusions: Left-sided pancreatic incidentalomas in patients with minor comorbidities can be safely treated with laparoscopic approach. Only clinical trials will confirm whether laparoscopic surgery is an effective treatment for malignant lesions.

Keywords: Distal pancreatectomy; Laparoscopic surgery; Pancreas; Pancreatic incidentaloma.

Fig. 1

Case 16. a CT scan demonstrating a 3 × 4 cm pancreatic tail cystic lesion. b Surgical specimen of spleen-preserving distal pancreatectomy with a cystic lesion of the tail. A well-demarcated, solitary, and cystic mass of the pancreatic tail is a rare macroscopic presentation of a neuroendocrine tumor. c The characteristic trabecular and gyriform pattern of a pancreatic neuroendocrine tumor with relatively uniform cells (hematoxylin-eosin; magnification ×40). d The immunohistochemical staining shows strong and diffuse expression of chromogranin A (magnification ×200)

Fig. 2

Case 2. a Surgical specimen of distal pancreatectomy containing a 9.5-cm-large encapsulated pancreatic tail mass with areas of cystic degeneration. The histological diagnosis was solid pseudopapillary neoplasm. b The microscopic pattern of the neoplasm is solid and pseudopapillary with poorly cohesive monomorphic cells, admixed with thin-walled blood vessels. At the center of the image, there are characteristic cholesterol crystals, surrounded by foreign-body giant cells (hematoxylin-eosin; magnification ×200)

Fig. 3

Case 6. a Histological picture of an acinar cell carcinoma: the neoplasm composed by cells arranged in small acinar units (hematoxylin-eosin; magnification ×200). b The immunohistochemical staining proves the expression of pancreatic exocrine enzymes (trypsin; magnification ×200)