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Dumitrascu T. Preservation of Pancreatic Function Should Not Be Disregarded When Performing Pancreatectomies for Pancreatoblastoma in Children. Pediatr Rep 2024; 16:385-398. [PMID: 38804376 PMCID: PMC11130799 DOI: 10.3390/pediatric16020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/05/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
Complete surgical resection in the context of a multimodal approach has been associated with excellent long-term survival in children diagnosed with pancreatoblastoma (PB). Traditionally, curative intent surgery for PB implies standard pancreatic resections such as pancreaticoduodenectomies and distal pancreatectomies with splenectomies, surgical procedures that may lead to significant long-term pancreatic functional deficiencies. Postoperative pancreatic functional deficiencies are particularly interesting to children because they may interfere with their development, considering their long life expectancy and the significant role of pancreatic functions in their nutritional status and growth. Thus, organ-sparing pancreatectomies, such as spleen-preserving distal pancreatectomies and central pancreatectomies, are emerging in specific tumoral pathologies in children. However, data about organ-sparing pancreatectomies' potential role in curative-intent PB surgery in children are scarce. Based on the literature data, the current review aims to present the early and late outcomes of pancreatectomies in children (including long-term deficiencies and their potential impact on the development and quality of life), particularly for PB, and further explore the potential role of organ-sparing pancreatectomies for PB. Organ-sparing pancreatectomies are associated with better long-term pancreatic functional outcomes, particularly central pancreatectomies, and have a reduced impact on children's development and quality of life without jeopardizing their oncological safety. The long-term preservation of pancreatic functions should not be disregarded when performing pancreatectomies for PB in children. A subset of patients with PB might benefit from organ-sparing pancreatectomies, particularly from central pancreatectomies, with the same oncological results as standard pancreatectomies but with significantly less impact on long-term functional outcomes.
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Affiliation(s)
- Traian Dumitrascu
- Division of Surgical Oncology, Fundeni Clinical Institute, Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Fundeni Street no. 258, 022328 Bucharest, Romania
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Xiang J, Zhu J, Wang H, Zhou X, Li H. Sixteen cases of laparoscopic central pancreatectomy for benign or low-grade malignant tumours in the pancreatic neck and proximal body. ANZ J Surg 2024; 94:888-893. [PMID: 38308435 DOI: 10.1111/ans.18893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND The purpose of this study is to examine and analyse the outcomes and patient experiences associated with laparoscopic central pancreatectomy. METHODS The perioperative data of 16 patients who underwent laparoscopic central pancreatectomy were retrospectively analysed at Ningbo Medical Center Lihuili Hospital (Xingning Branch and Eastern Branch) from September 2017 to July 2023. RESULTS All surgical procedures were completed without the need for intraoperative conversion to open surgery. In two cases, intraoperative cholangiography was performed, while in four cases, intraoperative fluoroscopic laparoscopic assistance was utilized. The duration of the operations varied from 160 to 360 min, with an average of 281.75 min. The estimated volume of intraoperative bleeding ranged from 50 to 300 mL, with an average of 113.75 mL. The postoperative pathology results revealed that there were two cases of intraductal papillary mucinous neoplasm, six cases of serous cystic neoplasms, one case of mucinous cystic neoplasm, five cases of solid pseudopapillary neoplasms, and two cases of neuroendocrine tumours. The maximum diameter of the tumours ranged from 3.0 to 5.0 cm, with an average of 3.67 cm. There were no instances of postoperative common bile duct stenosis or biliary leakage. Among the cases, five did not exhibit pancreatic fistula, six experienced biochemical leakage, three had grade B pancreatic fistula, and two had grade C pancreatic fistula. CONCLUSION Laparoscopic central pancreatectomy, as a method to preserve pancreatic function, entails specific surgical risks and a notable likelihood of postoperative pancreatic fistula, necessitating the expertise of seasoned surgeons for its execution.
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Affiliation(s)
- Jianqiang Xiang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Ningbo University, LiHuiLi Hospital, Ningbo, China
| | - Jie Zhu
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Ningbo University, LiHuiLi Hospital, Ningbo, China
| | - Haibiao Wang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Ningbo University, LiHuiLi Hospital, Ningbo, China
| | - Xinhua Zhou
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Ningbo University, LiHuiLi Hospital, Ningbo, China
| | - Hong Li
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Ningbo University, LiHuiLi Hospital, Ningbo, China
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Hirashita T, Fujinaga A, Nagasawa Y, Orimoto H, Amano S, Kawamura M, Kawasaki T, Kawano Y, Masuda T, Endo Y, Inomata M. Efficacy of pancreaticojejunostomy of the pancreatic stump during distal or central pancreatectomy. Langenbecks Arch Surg 2024; 409:145. [PMID: 38687358 DOI: 10.1007/s00423-024-03335-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND A stapler is usually used for transection and closure of the pancreas in distal pancreatectomy (DP) or central pancreatectomy (CP). When the pancreas is transected to the right of the portal vein, it is difficult to use a stapler and clinically relevant postoperative pancreatic fistula (CR-POPF) frequently occurs. We report on the efficacy of pancreaticojejunostomy (PJ) of the pancreatic stump for patients in whom stapler use is difficult. METHODS Patients who underwent DP or CP were enrolled in this study. The pancreas was usually transected by a stapler, and ultrasonic coagulating shears (UCS) were used depending on the tumor situation. When using UCS, hand-sewn closure or PJ was performed for the pancreatic stump. The relationship between clinicopathological factors and the methods of pancreatic transection and closure were investigated. RESULTS In total, 164 patients underwent DP or CP, and the pancreas was transected with a stapler in 150 patients and UCS in 14 patients. The rate of CR-POPF was higher and the postoperative hospital stay was longer in the UCS group than in the stapler group. PJ of the pancreatic stump, which was performed for 7 patients, did not worsen intraoperative factors. CR-POPF was not seen in these 7 patients, which was significantly less than that with hand-sewn closure. CONCLUSIONS PJ of the pancreatic stump during DP or CP reduces CR-POPF compared with hand-sewn closure and may be useful especially when the pancreas is transected to the right of the portal vein.
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Affiliation(s)
- Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
| | - Atsuro Fujinaga
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yuiko Nagasawa
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Hiroki Orimoto
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Shota Amano
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Masahiro Kawamura
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Takahide Kawasaki
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yoko Kawano
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Takashi Masuda
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yuichi Endo
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
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Agarwal J, Bhandare MS, Patel P, Sachanandani K, Yelamanchi R, Choudhari AK, Chaudhari B, Chaudhari VA, Shrikhande SV. Central versus distal pancreatectomy for low-grade and benign pancreatic neck-body tumours. Langenbecks Arch Surg 2024; 409:91. [PMID: 38467933 DOI: 10.1007/s00423-024-03285-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/07/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE Central pancreatectomy (CP) offers parenchymal preservation compared to conventional distal pancreato-splenectomy for pancreatic neck and body tumours. However, it is associated with more morbidity. This study is aimed at evaluating the peri-operative and long-term functional outcomes, comparing central and distal pancreatectomies (DPs). METHODS Retrospective analysis of patients undergoing pancreatic resections for low-grade malignant or benign tumours in pancreatic neck and body was performed (from January 2007 to December 2022). Preoperative imaging was reviewed for all cases, and only patients with uninvolved pancreatic tail, whereby a CP was feasible, were included. Peri-operative outcomes and long-term functional outcomes were compared between CP and DP. RESULTS One hundred twenty-two (5.2%) patients, amongst the total of 2304 pancreatic resections, underwent central or distal pancreatectomy for low-grade malignant or benign tumours. CP was feasible in 55 cases, of which 23 (42%) actually underwent CP and the remaining 32 (58%) underwent DP. CP group had a significantly longer operative time [370 min (IQR 300-480) versus 300 min (IQR 240-360); p = 0.002]; however, the major morbidity (43.5% versus 37.5%; p = 0.655) and median hospital stay (10 versus 11 days; p = 0.312) were comparable. The long-term endocrine functional outcome was favourable for the CP group [endocrine insufficiency rate was 13.6% in central versus 42.8% in distal (p = 0.046)]. CONCLUSION Central pancreatectomy offers better long-term endocrine function without any increased morbidity in low malignant potential or benign pancreatic tumours of neck and body region.
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Affiliation(s)
- Jasmine Agarwal
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Manish S Bhandare
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Prerak Patel
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kanchan Sachanandani
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Raghav Yelamanchi
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit K Choudhari
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bhushan Chaudhari
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vikram A Chaudhari
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shailesh V Shrikhande
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Terai T, Kawai M, Kitahata Y, Satoi S, Hashimoto D, Nagai M, Nishiwada S, Yamamoto T, Yamaue H, Sho M. Central pancreatectomy might be an acceptable surgical procedure for clinical T1 pancreatic body ductal adenocarcinoma: A multicenter retrospective analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:1334-1342. [PMID: 37792641 DOI: 10.1002/jhbp.1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Central pancreatectomy (CP) is accepted as a function-preserving procedure for benign tumors. However, the indication of CP for pancreatic cancers is limited. This multicenter study aimed to clarify the indications of CP for clinical T1 pancreatic body cancer. METHODS This multicenter study analyzed patients who underwent CP or distal pancreatectomy (DP) for clinical T1 pancreatic body cancer between 2013 and 2020 at three high-volume centers. RESULTS A total of 50 patients were enrolled: nine patients, who underwent CP, were classified into the CP group, while 38 patients, who underwent DP, served as controls. Three patients converted CP to DP during operation were excluded. Five patients in the CP group and 15 patients in the control group underwent preoperative treatment. The 5-year survival rate was 100% in the CP group, and 42% (p = .040) in the control group. Recurrence was found in three patients in the CP group. Importantly, insulin was not required after surgery in patients in the CP group. CONCLUSION The clinical outcomes of CP were comparable to or even better than that of conventional pancreatectomy. Our collaborative study suggests that CP may be an acceptable therapeutic option for selected patients with clinical T1 pancreatic body cancer.
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Affiliation(s)
- Taichi Terai
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Manabu Kawai
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yuji Kitahata
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Sohei Satoi
- Department of Surgery, Kansai Medical University, Hirakata City, Osaka, Japan
- Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daisuke Hashimoto
- Department of Surgery, Kansai Medical University, Hirakata City, Osaka, Japan
| | - Minako Nagai
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Satoshi Nishiwada
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Tomohisa Yamamoto
- Department of Surgery, Kansai Medical University, Hirakata City, Osaka, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
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Huang S, Zhang J, Huang Y. Laparoscopic distal pancreatectomy versus laparoscopic central pancreatectomy for benign or low-grade malignant tumors in the pancreatic neck. Langenbecks Arch Surg 2023; 408:355. [PMID: 37700188 DOI: 10.1007/s00423-023-03096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 09/05/2023] [Indexed: 09/14/2023]
Abstract
AIMS Laparoscopic distal pancreatectomy (LDP) and laparoscopic central pancreatectomy (LCP) are two surgical methods that can remove pancreatic neck lesions. However, their benefits remain controversial. We aimed to compare the benefits and limitations of LDP and LCP. METHODS In total, 50 patients who underwent LDP (n = 34) or LCP (n =16) between January 2014 and November 2019 were retrospectively reviewed using our database. We analyzed their preoperative characteristics, operative data, pathological features, and postoperative outcomes. RESULTS The baseline features of patients did not differ significantly between the two groups (P < 0.05). Compared with the LDP group, the LCP group showed significantly prolonged operation time (392 ± 144 vs. 269 ± 130 min, P = 0.007), time to oral intake (3.8 ± 1.3 vs. 2.8 ± 0.9 days, P = 0.017), and hospital stay (19.6 ± 5.1 vs. 15.4 ± 4.1 days, P = 0.008) as well as increased hospital expenses (10.1 ± 6.2 vs. 6.6 ± 1.5 WanRMB, P = 0.023). However, no significant differences were observed in conversion rate (0/16 vs. 0/34), blood loss (154 ± 93 vs. 211 ± 170 mL, P = 0.224), postoperative white blood cell count (10.3 ± 2.7 vs. 11.1 ± 3.1, P = 0.432), first random blood glucose level after operation (8.2 ± 2.1 vs. 8.6 ± 2.6 mmol/L, P = 0.696), and ascites amylase level on day 3 after operation (5212 [3110-14,176] vs. 3142 [604-13,761] U/L, P = 0.167) between the two groups. Moreover, no significant differences were noted in the incidence of postoperative diabetes (1/16 vs. 5/34) between the two groups. However, LCP was associated with significantly higher incidences of pancreatic fistula grades B and C (P = 0.005) and postoperative hemorrhage (P = 0.031). CONCLUSION Compared with the LCP, LDP is a useful and safer technique for benign or low-grade malignant tumors in the pancreatic neck.
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Affiliation(s)
- Song Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Jia Zhang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Yong Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
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Dumitrascu T, Popescu I. Outcomes of Duct-to-Mucosa vs. Invagination Pancreatojejunostomy: Toward a Personalized Approach for Distal Pancreatic Stump Anastomosis in Central Pancreatectomy? J Pers Med 2023; 13:jpm13050858. [PMID: 37241028 DOI: 10.3390/jpm13050858] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: The jejunum is primarily used for distal pancreatic stump anastomoses after central pancreatectomy (CP). The study aimed to compare duct-to-mucosa (WJ) and distal pancreatic invagination into jejunum anastomoses (PJ) after CP. (2) Methods: All patients with CP and jejunal anastomoses (between 1 January 2002 and 31 December 2022) were retrospectively assessed and compared. (3) Results: 29 CP were analyzed: WJ-12 patients (41.4%) and PJ-17 patients (58.6%). The operative time was significantly higher in the WJ vs. PJ group of patients (195 min vs. 140 min, p = 0.012). Statistically higher rates of patients within the high-risk fistula group were observed in the PJ vs. WJ group (52.9% vs. 0%, p = 0.003). However, no differences were observed between the groups regarding the overall, severe, and specific postpancreatectomy morbidity rates (p values ≥ 0.170). (4) Conclusions: The WJ and PJ anastomoses after CP were comparable in terms of morbidity rates. However, a PJ anastomosis appeared to fit better for patients with high-risk fistula scores. Thus, a personalized, patient-adapted technique for the distal pancreatic stump anastomosis with the jejunum after CP should be considered. At the same time, future research should explore gastric anastomoses' emerging role.
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Affiliation(s)
- Traian Dumitrascu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania
| | - Irinel Popescu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Titu Maiorescu University, 022328 Bucharest, Romania
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Sekkat H, Kada A, El Hamzaoui J, Yaka M, Elhjouji A, Ait Ali A. Middle segment pancreatectomy: Does it deserve a second chance? Report of three cases and review of the literature. Int J Surg Case Rep 2023; 107:108268. [PMID: 37187113 DOI: 10.1016/j.ijscr.2023.108268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Meddle segment pancreatectomy (MP) is a parenchyma-sparing surgical procedure that has recently been proposed for treatment of benign or attenuated malignant tumors. However, this procedure is not fully recognized. CASE PRESENTATION We herein report 3 patients undergoing MP for tumors of pancreas body and tail. The first patient was a 38-year-old woman with a neuroendocrine tumor, the second was a 42-year-old woman with a serous cystic neoplasm and the 3rd patient was 57 years old, with mucinous cystadenoma. A MP with spleen preservation was performed in the 3 patients, with ligatures of splenic vessels in the first patient. Only one patient developed a pancreatic fistula, which was managed medically. In our 3 patients, no endocrine or exocrine insufficiency was observed, but the first patient showed a disease recurrence with liver metastasis 3 years after surgery. CLINICAL DISCUSSION Middle pancreatectomy can not only avoid the pancreatic effects of extensive resections, but it is also a technique that has a very low operative or postoperative mortality rate. CONCLUSION MP is a feasible, safe procedure with several advantages, but which unfortunately remains rarely practiced.
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Affiliation(s)
- Hamza Sekkat
- Department of Digestive Surgery II, Mohammed V Military Hospital, 10100 Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco.
| | - Ali Kada
- Department of Digestive Surgery II, Mohammed V Military Hospital, 10100 Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Jihane El Hamzaoui
- Department of Digestive Surgery II, Mohammed V Military Hospital, 10100 Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Mbarek Yaka
- Department of Digestive Surgery II, Mohammed V Military Hospital, 10100 Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Abderrahman Elhjouji
- Department of Digestive Surgery II, Mohammed V Military Hospital, 10100 Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Abdelmounaïm Ait Ali
- Department of Digestive Surgery II, Mohammed V Military Hospital, 10100 Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
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Pausch TM, Liu X, Dincher J, Contin P, Cui J, Wei J, Heger U, Lang M, Tanaka M, Heap S, Kaiser J, Klotz R, Probst P, Miao Y, Hackert T. Middle Segment-Preserving Pancreatectomy to Avoid Pancreatic Insufficiency: Individual Patient Data Analysis of All Published Cases from 2003-2021. J Clin Med 2023; 12:jcm12052013. [PMID: 36902800 PMCID: PMC10003839 DOI: 10.3390/jcm12052013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Middle segment-preserving pancreatectomy (MPP) can treat multilocular diseases in the pancreatic head and tail while avoiding impairments caused by total pancreatectomy (TP). We conducted a systematic literature review of MPP cases and collected individual patient data (IPD). MPP patients (N = 29) were analyzed and compared to a group of TP patients (N = 14) in terms of clinical baseline characteristics, intraoperative course, and postoperative outcomes. We also conducted a limited survival analysis following MPP. Pancreatic functionality was better preserved following MPP than TP, as new-onset diabetes and exocrine insufficiency each occurred in 29% of MPP patients compared to near-ubiquitous prevalence among TP patients. Nevertheless, POPF Grade B occurred in 54% of MPP patients, a complication avoidable with TP. Longer pancreatic remnants were a prognostic indicator for shorter and less eventful hospital stays with fewer complications, whereas complications of endocrine functionality were associated with older patients. Long-term survival prospects after MPP appeared strong (median up to 110 months), but survival was lower in cases with recurring malignancies and metastases (median < 40 months). This study demonstrates MPP is a feasible treatment alternative to TP for selected cases because it can avoid pancreoprivic impairments, but at the risk of perioperative morbidity.
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Affiliation(s)
- Thomas M. Pausch
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-565150
| | - Xinchun Liu
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Department of Gastrointestinal Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Josefine Dincher
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Pietro Contin
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Jiaqu Cui
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Jishu Wei
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ulrike Heger
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Matthias Lang
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Masayuki Tanaka
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Stephen Heap
- Study Center of the German Society of Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Jörg Kaiser
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Rosa Klotz
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Study Center of the German Society of Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Pascal Probst
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Department of Surgery, Cantonal Hospital Thurgau, 8501 Frauenfeld, Switzerland
| | - Yi Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
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10
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Bansal AK, Nagari B, Nekarakanti PK, Pakkala AK, Thumma VM, Gunturi SRV, Pardasani M. Is central pancreatectomy an effective alternative to distal pancreatectomy for low-grade pancreatic neck and body tumors: A 20-year single-center propensity score-matched case-control study. Ann Hepatobiliary Pancreat Surg 2023; 27:87-94. [PMID: 36414235 PMCID: PMC9947365 DOI: 10.14701/ahbps.22-042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/04/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022] Open
Abstract
Backgrounds/Aims Central pancreatectomy (CP) is associated with a higher rate of postoperative pancreatic fistula (POPF), and it is less preferred over distal pancreatectomy (DP). We compared the short- and long-term outcomes between CP and DP for low-grade pancreatic neck and body tumors. Methods This was a propensity score-matched case-control study of patients who underwent either CP or DP for low-grade pancreatic neck and body tumors from 2003 to 2020 in a tertiary care unit in southern India. Patients with a tumor >10 cm or a distal residual stump length of < 4 cm were excluded. Demographics, clinical profile, intraoperative and postoperative parameters, and the long-term postoperative outcomes for exocrine and endocrine insufficiency, weight gain, and the 36-Item Short Form Survey (SF-36) quality of life questionnaire were compared. Results Eighty-eight patients (CP: n=37 [cases], DP: n=51 [control]) were included in the unmatched group after excluding 21 patients (meeting exclusion criteria). After matching, both groups had 37 patients. The clinical and demographic profiles were comparable between the two groups. Blood loss and POPF rates were significantly higher in the CP group. However, Clavien-Dindo grades of complications were similar between the two groups (p = 0.27). At a median follow-up of 38 months (range = 187 months), exocrine sufficiency was similar between the two groups. Endocrine sufficiency, weight gain, SF-36 pain control score, and general health score were significantly better in the CP group. Conclusions Despite equivalent clinically significant morbidities, long-term outcomes are better after CP compared to DP in low-grade pancreatic body tumors.
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Affiliation(s)
- Ashish Kumar Bansal
- Department of Surgical Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Bheerappa Nagari
- Department of Surgical Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad, India,Corresponding author: Bheerappa Nagari, MS Department of Surgical Gastroenterology, Nizam’s Institute of Medical Sciences, Punjagutta Rd, Punjagutta Market, Punjagutta, Hyderabad 500082, India Tel: +91-9949092298, Fax: +91-40-23310076, E-mail: ORCID: https://orcid.org/0000-0003-1953-4793
| | - Phani Kumar Nekarakanti
- Department of Surgical Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Amith Kumar Pakkala
- Department of Surgical Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Venu Madhav Thumma
- Department of Surgical Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | | | - Madhur Pardasani
- Department of Surgical Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad, India
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11
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Yang D, Li M, Li Z, Zhang L, Hu W, Ke N, Xiong J. Laparoscopic versus open central pancreatectomy: a propensity score-matched analysis in a single centre. Langenbecks Arch Surg 2023; 408:40. [PMID: 36652008 DOI: 10.1007/s00423-023-02752-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/23/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE Laparoscopic central pancreatectomy (LCP) has been implemented in pancreatic surgery; however, open surgery is still the predominant approach for central pancreatectomy (CP). Our objective was to compare LCP with open CP (OCP). METHODS Data were collected from patients with tumours located in the pancreatic neck and proximal body who underwent CP in the Department of Pancreatic Surgery West China Hospital from January 1, 2010, to June 30, 2019. A comparison between the LCP and OCP groups was performed. RESULTS Fifteen patients underwent CP via the laparoscopic approach, and 96 patients underwent CP via the open approach. Using 1:2 propensity score matching (PSM), 12 patients in the LCP group were matched to 21 in the OCP group. Regarding safety, postoperative pancreatic fistula (POPF) was not significantly different between the two groups (13.3% vs. 12.5%, P = 1.000), even with PSM (16.7% vs. 14.3%, P = 1.000). However, regarding effectiveness, the operative time in the OCP group was significantly shorter than that in the LCP group before (307.0 ± 92.3 ml vs. 220.6 ± 63.6 ml, P < 0.000) and after (300.3 ± 90.2 ml vs. 212.7 ± 44.4 ml, P = 0.002) PSM. Regarding length of stay (LOS), there was no difference between the two groups before (13.1 ± 13.7 days vs. 12.7 ± 10.1 days, P = 0.376) and after PSM (14.4 ± 15.1 days vs. 14.5 ± 16.2 days, P = 0.985). The length of the resected pancreas was shorter in the OCP group than in the LCP group before PSM (50.0 ± 13.2 mm vs. 41.1 ± 11.1 mm, P = 0.043). However, there was no difference between the two groups after PSM (47.9 ± 12.5 mm vs. 37.9 ± 10.4 mm, P = 0.084). Moreover, the other variables showed no difference between the two groups before and after PSM. CONCLUSION LCP can demonstrate similar safety and effectiveness to OCP, even in the early stages of the learning curve.
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Affiliation(s)
- Dujiang Yang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan Province, China
| | - Mao Li
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan Province, China
| | - Zhenlu Li
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan Province, China
| | - Ling Zhang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan Province, China
| | - Weiming Hu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan Province, China
| | - Nengwen Ke
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan Province, China
| | - Junjie Xiong
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, Sichuan Province, China.
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12
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Abstract
Neuroendocrine tumors (NETs) represent a heterogeneous group of tumors, with variable presentation based on the location of origin and degree of metastatic spread. There are no randomized control trials to guide surgical management; however, surgery remains the mainstay of treatment for most gastroenteropancreatic NETs based on retrospective studies. Metastatic disease is common at the time of presentation, particularly in the liver. There is a role for cytoreduction for improvement of both symptoms and survival. Robust prospective randomized data exists to support the use of medical therapies to improve progression-free and overall survival in patients with advanced, metastatic, and unresectable NETs.
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Ouyang L, Liu RD, Ren YW, Nie G, He TL, Li G, Zhou YQ, Huang ZP, Zhang YJ, Hu XG, Jin G. Nomogram predicts CR-POPF in open central pancreatectomy patients with benign or low-grade malignant pancreatic neoplasms. Front Oncol 2022; 12:1030080. [PMID: 36591477 PMCID: PMC9797993 DOI: 10.3389/fonc.2022.1030080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Central pancreatectomy (CP) is a standard surgical procedure for benign and low-grade malignant pancreatic neoplasms in the body and neck of the pancreas. Higher incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) after CP than after pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) has been reported, but no nomogram for prediction of CR-POPF after open CP has been previously established. Methods Patients undergoing open CP for benign or low-grade malignant pancreatic neoplasms in the department of Hepatobiliary and Pancreatic (HBP) surgery of Shanghai Changhai Hospital affiliated to Naval Medical University between January 01, 2009 and December 31,2020 were enrolled. Pre-, intra- and post-operative parameters were analyzed retrospectively. Results A total of 194 patients, including 60 men and 134 women, were enrolled with median age of 52 years (21~85 years). 84 patients (43.3%) were overweight (BMI>23.0 Kg/m2) and 14 (7.2%) were obese (BMI>28.0 Kg/m2). Pathological diagnoses ranged from serous cystic neoplasm (32.5%), solid pseudopapillary neoplasm (22.2%), pancreatic neuroendocrine tumor (20.1%), intraductal papillary mucinous neoplasm (18.0%) to mucinous cystic neoplasm (5.2%). All patients had soft pancreatic texture. Main pancreatic duct diameters were ≤0.3cm for 158 patients (81.4%) and were ≥0.5cm in only 12 patients (6.2%). A stapler (57.7%) or hand-sewn closure (42.3%) were used to close the pancreatic remnant. The pancreatic anastomosis techniques used were duct to mucosa pancreaticojejunostomy (PJ)-interrupted suture (47.4%), duct to mucosa PJ-continuous suture (43.3%), duct to mucosa "HO" half-purse binding PJ (5.2%) and invaginating pancreaticogastrostomy (4.1%). Post-surgical incidences of CR-POPF of 45.9%, surgical site infection of 28.9%, postpancreatectomy hemorrhage of 7.7% and delayed gastric emptying of 2.1% were found. Obesity and pancreatic anastomosis technique were independent risk factors of CR-POPF, with a concordance index of 0.675 and an Area Under the Curve of 0.678. Discussion This novel nomogram constructed according to obesity and pancreatic anastomosis technique showed moderate predictive performance of CR-POPF after open CP.
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Affiliation(s)
- Liu Ouyang
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ren-dong Liu
- Department of Hepatobiliary Surgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Yi-wei Ren
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Gang Nie
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Tian-lin He
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Gang Li
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ying-qi Zhou
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhi-ping Huang
- Department of Hepatobiliary Surgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Yi-jie Zhang
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China,*Correspondence: Gang Jin, ; Xian-gui Hu, ; Yi-jie Zhang,
| | - Xian-gui Hu
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China,*Correspondence: Gang Jin, ; Xian-gui Hu, ; Yi-jie Zhang,
| | - Gang Jin
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China,*Correspondence: Gang Jin, ; Xian-gui Hu, ; Yi-jie Zhang,
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14
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de Ponthaud C, Grégory J, Pham J, Martin G, Aussilhou B, Ftériche FS, Lesurtel M, Sauvanet A, Dokmak S. Resection of the splenic vessels during laparoscopic central pancreatectomy is safe and does not compromise preservation of the distal pancreas. Surgery 2022; 172:1210-1219. [PMID: 35864049 DOI: 10.1016/j.surg.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 04/16/2022] [Accepted: 05/10/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The diagnosis of low potential malignant diseases is increasingly frequent, and laparoscopic central pancreatectomy can be indicated in these patients. Laparoscopic central pancreatectomy that usually preserves the splenic vessels results in a low risk of new-onset diabetes but high morbidity, mainly due to postoperative pancreatic fistula and postpancreatectomy hemorrhage. In this study, we evaluated the short and long-term complications after laparoscopic central pancreatectomy with splenic vessel resection. METHODS This retrospective single-center cohort study included 650 laparoscopic pancreatic resections from 2008 to 2020 with 84 laparoscopic central pancreatectomy; 15 laparoscopic central pancreatectomy with splenic vessel resection; and 69 laparoscopic central pancreatectomy with preservation of the splenic vessels. Pancreaticogastrostomy was routinely performed, and the patients were discharged after complications had been treated. The 15 laparoscopic central pancreatectomy with splenic vessel resection were matched for age, sex, body mass index, and tumor characteristics [1:2] and compared with 30 laparoscopic central pancreatectomy with the preservation of the splenic vessels. RESULTS In the laparoscopic central pancreatectomy with splenic vessel resection group, resection of splenic vessels was performed due to tumoral or inflammatory adhesions (n = 11) or accidental vascular injury (n = 4). The demographic characteristics of the groups were similar. Tumors were larger in the laparoscopic central pancreatectomy with splenic vessel resection group (40 vs 21 mm; P = .008), and right transection on the body of the pancreas (53% vs 13%; P = .01) was more frequent. There were no differences in the characteristics of the pancreas (Wirsung duct size or consistency). The median operative time (minutes) was longer in the laparoscopic central pancreatectomy with splenic vessel resection group than in the laparoscopic central pancreatectomy with preservation of the splenic vessels group (210 vs 180, respectively; P = .15) with more blood loss (100 mL vs 50 mL, respectively; P = .012). The lengths (mm) of the resected pancreas and remnant distal pancreas in the 2 groups were 65 vs 50 (P = .053) and 40 vs 65 (P = .006), respectively. There were no differences in postoperative mortality (0% vs 3%; P = .47), grade B-C postoperative pancreatic fistula (27% vs 27%; P = 1), reintervention (7% vs 13%; P = .50), grade B-C postpancreatectomy hemorrhage (0% vs 13%; P = .13), length of hospital stay (20 days vs 22 days; P = .15), or new-onset diabetes (7% vs 10%; P = .67) between the 2 groups. CONCLUSION Laparoscopic central pancreatectomy with splenic vessel resection is a safe technical modification of central pancreatectomy that does not prevent preservation of the distal pancreas and does not influence postoperative pancreatic fistula or endocrine insufficiency. Furthermore, it could reduce the risk of postpancreatectomy hemorrhage.
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Affiliation(s)
- Charles de Ponthaud
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, Clichy, France
| | - Jules Grégory
- AP-HP, Hôpital Beaujon, Department of Radiology, Clichy, France; University of Paris Cité, Paris, France
| | - Julie Pham
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, Clichy, France
| | - Grégory Martin
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, Clichy, France
| | - Béatrice Aussilhou
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, Clichy, France
| | - Fadhel Samir Ftériche
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, Clichy, France
| | - Mickael Lesurtel
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, Clichy, France; University of Paris Cité, Paris, France
| | - Alain Sauvanet
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, Clichy, France; University of Paris Cité, Paris, France
| | - Safi Dokmak
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, Clichy, France.
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15
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Cai H, Feng L, Peng B. Laparoscopic pancreatectomy for benign or low-grade malignant pancreatic tumors: outcomes in a single high-volume institution. BMC Surg 2021; 21:412. [PMID: 34876071 PMCID: PMC8650331 DOI: 10.1186/s12893-021-01414-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/29/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To investigate the perioperative and long-term outcomes of laparoscopic pancreatectomy for benign and low-grade malignant pancreatic tumors, and further compare the outcomes between different surgical techniques. METHODS We retrospectively collected clinical data of consecutive patients with benign or low-grade malignant pancreatic tumors underwent surgery from February 2014 to February 2019. Patients were grouped and compared according to different surgical operations they accepted. RESULTS Totally 164 patients were reviewed and 83 patients underwent laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD), 41 patients underwent laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and 20 patients underwent laparoscopic central pancreatectomy (LCP) were included in this study, the rest 20 patients underwent laparoscopic enucleation were excluded. There were 53 male patients and 91 female patients. The median age of these patients was 53.0 years (IQR 39.3-63.0 years). The median BMI was 21.5 kg/m2 (IQR 19.7-24.0 kg/m2). The postoperative severe complication was 4.2% and the 90-days mortality was 0. Compare with LCP group, the LPPPD and LSPDP group had longer operation time (300.4 ± 89.7 vs. 197.5 ± 30.5 min, P < 0.001) while LSPDP group had shorter operation time (174.8 ± 46.4 vs. 197.5 ± 30.5 min, P = 0.027), more blood loss [140.0 (50.0-1000.0) vs. 50.0 (20.0-200.0) ml P < 0.001 and 100.0 (20.0-300.0) vs. 50.0 (20.0-200.0 ml, P = 0.039, respectively), lower rate of clinically relevant postoperative pancreatic fistula [3 (3.6%) vs. 8 (40.0%), P < 0.001 and 3 (7.3%) vs. 8 (40.0%), P = 0.006, respectively], lower rate of postpancreatectomy hemorrhage [0 (0%) vs. 2 (10.0%), P = 0.036 and (0%) vs. 2 (10.0%) P = 0.104, respectively] and lower rate of postoperative severe complications [2 (2.4%) vs.4 (20.0%), P = 0.012 and 0 (0%) vs. 4 (20.0%), P = 0.009, respectively], higher proportion of postoperative pancreatin and insulin treatment (pancreatin: 39.8% vs., 15% P = 0.037 and 24.4%vs. 15%, P = 0.390; insulin: 0 vs. 18.1%, P = 0.040 and 0 vs. 12.2%, P = 0.041). CONCLUSIONS Overall, laparoscopic pancreatectomy could be safely performed for benign and low-grade malignant pancreatic tumors while the decision to perform laparoscopic central pancreatectomy should be made carefully for fit patients who can sustain a significant postoperative morbidity and could benefit from the excellent long-term results even in a high-volume center.
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Affiliation(s)
- He Cai
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.,Department of Minimal Invasive Surgery, Shangjin Nanfu Hosptial, Chengdu, China
| | - Lu Feng
- Operating Room of Anesthesia Surgery Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Bing Peng
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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16
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Girish S, Kapil N, Kannan N. Central Pancreatectomy: Significance of Vascularity on Anastomotic Integrity and a Note on Reconstructive Technique. Cureus 2021; 13:e18617. [PMID: 34765372 PMCID: PMC8573194 DOI: 10.7759/cureus.18617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/05/2022] Open
Abstract
Central pancreatectomy is a pancreatic parenchymal sparing surgery usually indicated for benign and borderline malignant tumors of the neck and proximal body of the pancreas. Due to the presence of extensive intra-pancreatic spread, pancreatic parenchyma sparing procedures such as central pancreatectomy are invariably deferred in pancreatic malignancy. The need for management of two pancreatic stumps with a usually soft texture and non-dilated ducts, given the indications, increases the risk of pancreatic fistula and therefore morbidity. Proximal stump management is usually a closure either by suture or stapler with reinforcements; the technique preferred depends on the experience of the surgeon and is mostly extrapolated from distal pancreatectomy. Distal stump management is the Achilles’ heel owing to the texture of the pancreas and pancreatic duct size. Need for additional mobilization may have a bearing on the perfusion of the pancreatic stump and hence may lead to clinically relevant leaks. The use of octreotide accentuating the said vascular insufficiency may not be an overstatement. Here we present a case of solid pseudopapillary tumor (SPT) of the neck and proximal body of the pancreas in which a central pancreatectomy with falciform patch closure of the proximal stump and binding pancreaticogastrostomy (PG) was contemplated and further we discuss the types of reconstruction with special reference to the vascular pattern of distal pancreas.
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Affiliation(s)
- Suraj Girish
- General Surgery, Meenakshi Medical College and Research Institute, Kanchipuram, IND
| | - Nagaraj Kapil
- Surgical Gastroenterology, Meenakshi Medical College and Research Institute, Kanchipuram, IND
| | - Naveen Kannan
- General Surgery, Meenakshi Medical College Hospital and Research Institute, Kanchipuram, IND
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17
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Wen K, Cen C, Wu L, Huang M, Yang H, Yue X, Zhang Y, Ma G, Li X, Han P. Relationship between pancreatic parenchyma loss and early postoperative hyperglycemia in patients with benign pancreatic diseases. Abdom Radiol (NY) 2021; 46:4210-4217. [PMID: 33813625 PMCID: PMC8346412 DOI: 10.1007/s00261-021-03061-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 11/18/2022]
Abstract
Objective To evaluate the relationship between pancreatic parenchyma loss and early postoperative hyperglycemia in patients with benign pancreatic diseases. Methods A total of 171 patients with benign pancreatic tumors or chronic pancreatitis, whose preoperative fasting blood glucose (FBG) was normal and who underwent partial pancreatectomy were reviewed. The pancreatic volume was measured by CT imaging before and after the operation. According to their different pancreatic resection volume (PRV), 171 patients were divided into five groups: < 30%, 30%–39%, 40%–49%, 50%–59%, and ≥ 60%. The correlation between the PRV and postoperative FBG was investigated. According to the postoperative FBG value, the patients were divided into a hyperglycemia group (HG) and nonhyperglycemia group (non-HG) to explore the best cutoff value of the PRV between the two groups. Results There were significant differences in the postoperative FBG among the five groups (PRV < 30%, 30%–39%, 40%–49%, 50%–59%, and ≥ 60%). The PRV was positively correlated with postoperative FBG in the benign tumor group and chronic pancreatitis group (R = 0.727 and 0.651, respectively). ROC curve analysis showed that the best cutoff value of the PRV between the HG (n = 84) and non-HG (n = 87) was 39.95% with an AUC = 0.898; the sensitivity was 89.29%, and the specificity was 82.76%. Conclusion There was a linear positive correlation between the postoperative FBG level and PRV. Patients with a PRV ≥ 40% are more likely to develop early postoperative hyperglycemia.
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18
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Yamamoto-Kataoka S, Shimizu S, Yamazaki H, Murakami K, Nishizaki D, Fukuhara S, Inagaki N, Yamamoto Y. Development of a preoperative prediction model for new-onset diabetes mellitus after partial pancreatectomy: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e26311. [PMID: 34128870 PMCID: PMC8213311 DOI: 10.1097/md.0000000000026311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 05/25/2021] [Indexed: 11/28/2022] Open
Abstract
Pancreatectomy is an invasive surgery that is sometimes associated with complications. New-onset diabetes mellitus sometimes develops after partial pancreatectomy and severely affects the patient's quality of life. This study aimed to develop a preoperative prediction model of new-onset diabetes mellitus after partial pancreatectomy, which will help patients and surgeons to achieve more easily better common decisions on regarding whether to perform partial pancreatectomy. This retrospective cohort study analyzed medical records of patients who underwent partial pancreatectomy (total pancreatectomy excluded) from April 1, 2008, to February 28, 2016, which were available in the database provided by Medical Data Vision Co., Ltd. (Tokyo, Japan). The predictors were preoperative age, body mass index, hemoglobin A1c level, blood glucose level, and indication for partial pancreatectomy. The outcome was the development of new-onset diabetes mellitus at 1 to 12 months after partial pancreatectomy. We used a logistic regression model and calculated the scores of each predictor. To determine test performance, we assessed discrimination ability using the receiver operating characteristic curve and calibration with a calibration plot and the Hosmer-Lemeshow test. We also performed internal validation using the bootstrap method. Of 681 patients, 125 (18.4%) had new-onset diabetes mellitus after partial pancreatectomy. The developed prediction model had a possible range of 0 to 46 points. The median score was 13, and the interquartile range was 9 to 22. The C-statistics of the receiver operating characteristic curve on the score to predict the outcome was .70 (95% confidence interval [CI], .65-.75). Regarding the test performance, the Hosmer-Lemeshow test was not significant (P = .17), and calibration was good. In the bootstrapped cohorts, the C-statistics was .69 (95% CI, .62-.76). We developed a preoperative prediction model for new-onset diabetes mellitus after partial pancreatectomy. This would provide important information for surgeons and patients when deciding whether to perform partial pancreatectomy.
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Affiliation(s)
- Sachiko Yamamoto-Kataoka
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine
| | - Sayaka Shimizu
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine
- Section of Clinical Epidemiology, Department of Community Medicine
| | - Hajime Yamazaki
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine
- Section of Clinical Epidemiology, Department of Community Medicine
| | - Katsuhiro Murakami
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto
| | - Daisuke Nishizaki
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine
- Section of Clinical Epidemiology, Department of Community Medicine
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima City, Fukushima
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine
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19
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Sacco K, Khan TM, Passi M, Hernandez JM, Komarow H. Pancreatic neuroendocrine tumor presenting in indolent systemic mastocytosis: A case report. Int J Surg Case Rep 2020; 77:397-402. [PMID: 33220657 PMCID: PMC7688994 DOI: 10.1016/j.ijscr.2020.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/02/2022] Open
Abstract
Systemic mastocytosis and neuroendocrine tumors may present with similar symptoms. Co-occurrence of both diseases may be due to activating mutations in KIT. Recognition of these distinct diseases is necessary to ensure timely treatment.
Introduction Systemic mastocystosis, a disorder of clonal mast cell expansion presents with symptoms of flushing, pruritus, musculoskeletal pain, gastrointestinal cramping and vascular instability. Patients with neuroendocrine tumors may present with similar symptoms due to the release of vasoactive mediators in both diseases. We report the co-occurrence of systemic mastocytosis and a neuroendocrine pancreatic tumor for which the patient received disease-specific treatment. Case presentation A 58-year-old woman with a history of indolent systemic mastocytosis and a serum tryptase of 51 ng/mL was diagnosed with a solid pancreatic lesion on ultrasound when assessing for organomegaly. Lesional biopsy was consistent with a pancreatic neuroendocrine tumor which was successfully resected. Discussion Presenting symptoms such as skin rashes, flushing, fatigue and diarrhea, are similar for systemic mastocytosis and neuroendocrine tumors. The co-occurrence of both diseases has not been previously reported. Activating mutations in KIT, which are a hallmark of systemic mastocytosis, may drive neoplastic proliferation in neuroendocrine tumors. Furthermore, mast cells infiltrating pancreatic tissue may have a trophic effect on the development of pancreatic neuroendocrine tumors. Conclusion While challenging to diagnose both diseases presenting with similar symptoms, recognition of these distinct diseases is necessary to ensure timely treatment.
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Affiliation(s)
- Keith Sacco
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States
| | - Tahsin M Khan
- National Cancer Institute, NIH, Bethesda, MD, United States
| | - Monica Passi
- National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD, United States
| | | | - Hirsh Komarow
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States.
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20
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Kotecha K, Mittal A, Gill AJ, Samra JS. Formation of a splenic artery aneurysm within a pancreatic mucinous cystic neoplasm. ANZ J Surg 2020; 91:E407-E408. [PMID: 33217145 DOI: 10.1111/ans.16443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Krishna Kotecha
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anubhav Mittal
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Anthony J Gill
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jaswinder S Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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21
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Cloyd JM, Poultsides GA. The Landmark Series: Pancreatic Neuroendocrine Tumors. Ann Surg Oncol 2020; 28:1039-1049. [PMID: 32948965 DOI: 10.1245/s10434-020-09133-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/29/2020] [Indexed: 12/23/2022]
Abstract
Pancreatic neuroendocrine tumors (PNETs) comprise a heterogeneous group of neoplasms arising from pancreatic islet cells that remain relatively rare but are increasing in incidence worldwide. While significant advances have been made in recent years with regard to systemic therapies for patients with advanced disease, surgical resection remains the standard of care for most patients with localized tumors. Although formal pancreatectomy with regional lymphadenectomy is the standard approach for most PNETs, pancreas-preserving approaches without formal lymphadenectomy are acceptable for smaller tumors at low risk for lymph node metastases. Furthermore, observation of small, asymptomatic, low-grade PNETs is a safe, initial strategy and is generally recommended for tumors < 1 cm in size. In this Landmark Series review, we highlight the critical studies that have defined the surgical management of PNETs.
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Affiliation(s)
- Jordan M Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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