Introduction : It is often difficult to apply Laparoscopic distal pancreatectomy (LDP) for pancreatic ductal adenocarcinoma (PDAC) because its aggressive invasion to adjacent organs or major vessels. The objective of this study was to report our experiences for laparoscopic extended pancreatectomy with en-bloc resection of adjacent organs or major vessels for left-sided PDAC.

Methods : We reviewed data for all patients undergoing LDP for left-sided PDAC at Asan Medical Center between April 2006 and December 2016. The patients who underwent laparoscopic extended panreatectomy were included in analyses.

Results : Of 257 patients, 21 underwent laparoscopic extended pancreatectomy. There were 14 male,7 femal and median age was 64.1 years. Resected adjacent organs were stomach in 6, duodenum in 1, colon in 4, kidney in 2, superior mesenteric vein in 4, and celiac axis in 4. Median operative duration was 280 minutes, and median length of hospital stay was 9 days. Pathological reports revealed the following: a median tumor size of 3.5 cm, T stages (T1 in 1, T3 in 18, and T4 in 2), and N stages (N0 in 10 and N1 in 11). R0 resection was achieved in 6 patients, and most R1 resection were tangential retroperitoneal margins. Clinically relevant postoperative pancreatic fistula was occured in 2 patients, and there was no 90-day mortality. Median overall survival was 19.6 months and 1 year survival rate was 71.1%.

Conclusions : Although laparoscopic surgery has limitations in treating extensive diseases, some selected patients can be applicable for laparoscopic extended pancreatectomy with acceptable complication and survival rates.