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Codjia T, Marique L, Aussilhou B, Ftériche FS, de Mestier L, Rebours V, Cros J, Ruszniewski P, Lévy P, Lesurtel M, Sauvanet A, Dokmak S. Outcome and survival were similar with laparoscopic and open pancreatectomy in 102 solid pseudopapillary neoplasms. Surg Endosc 2024; 38:2169-2179. [PMID: 38448620 DOI: 10.1007/s00464-024-10708-y] [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: 10/11/2023] [Accepted: 01/21/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Solid pseudopapillary neoplasms of the pancreas (SPNP) are rare tumors predominantly in young women. We report the largest single-center cohort study comparing resection of SPNP by laparoscopic approach (LA) and the open approach (OA). METHOD Between 2001 and 2021, 102 patients (84% women, median age: 30) underwent pancreatectomy for SPNP and were retrospectively studied. Demographic, perioperative, pathological, early and the long-term results were evaluated between patients operated by LA and those by OA. RESULTS Population included 40 LA and 62 OA. There were no significant differences in demographics data between the groups. A preoperative biopsy by endoscopic ultrasound was performed in 45 patients (44%) with no difference between the groups. Pancreatoduodenectomy (PD) was less frequently performed by LA (25 vs 53%, p = 0.004) and distal pancreatectomy (DP) was more frequently performed by LA (40 vs 16%, p = 0.003). In the subgroup analysis by surgical procedure, LA-PD was associated with one mortality, less median blood loss (180 vs 200 ml, p = 0.034) and fewer harvested lymph nodes (11 vs 15, p = 0.02). LA-DP was associated with smaller median tumor size on imaging (40 vs 80mm, p = 0.048), shorter surgery (135 vs 190 min, p = 0.028), and fewer complications according to the median comprehensive complication index score (0 vs 8.7, p = 0.048). LA-Central pancreatectomy was associated with shorter surgery (160 vs 240, p = 0.037), less median blood loss (60 vs 200, p = 0.043), and less harvested lymph nodes (5 vs 2, p = 0.025). After a median follow-up of 60 months, two recurrences (2%) were observed and were unrelated to the approach. CONCLUSIONS The LA for SPNP appears to be safe, should be applied cautiously in case of PD for large lesion, and was not associated with recurrence.
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Affiliation(s)
- Tatiana Codjia
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Lancelot Marique
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Béatrice Aussilhou
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Fadhel Samir Ftériche
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Louis de Mestier
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Vinciane Rebours
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Jérome Cros
- AP-HP, Hôpital Beaujon, Department of Pathology, University Paris Cité, Clichy, France
| | - Philippe Ruszniewski
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Philippe Lévy
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Mickael Lesurtel
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Alain Sauvanet
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Safi Dokmak
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France.
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Hirao H, Isono K, Abe Y, Imai K, Honda M, Hibi T. Precision anatomy for minimally invasive spleen-preserving distal pancreatectomy in children: A case report of solid-pseudopapillary neoplasm in a 12-year-old girl. Int J Surg Case Rep 2023; 110:108639. [PMID: 37598488 PMCID: PMC10469524 DOI: 10.1016/j.ijscr.2023.108639] [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: 04/12/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION Solid pseudopapillary neoplasm (SPN) is a rare and low malignant tumor found mainly in young females. There is no standardized procedure for SPN of the pancreatic body and tail in children. In adults, an international consensus on precision anatomy for minimally invasive distal pancreatectomy (MIDP) was established recently (PAM-HBP Surgery Project). The aim of this study is to demonstrate that precision anatomy can also be safely and effectively implemented in the pediatric population. PRESENTATION OF CASE A 12-year-old girl with an incidentally found SPN located in the pancreatic tail was referred to our hospital. She successfully underwent an R0 resection by laparoscopic spleen-preserving distal pancreatectomy (LSPDP) under the concept of precision anatomy. The patient recovered uneventfully and was discharged on day 7. DISCUSSION This is the first successful report of LSPDP under the concept of precision anatomy in children. In accordance with the recommendations from the international consensus, the "anterior approach" was selected to dissect and encircle the splenic artery based on the vascular anatomy identified by preoperative imaging. The dorsal dissection border of the pancreas along the anterior layer above the Gerota's fascia was carefully maintained and the splenic vessels were preserved taking into consideration the low malignant potential of SPN and to decrease the risk of complications associated with splenectomy, which were also the essential issues of the consensus. CONCLUSION The implementation of precision anatomy for pediatric pancreas surgery should facilitate the safe diffusion of MIDP for SPN and other benign or low-malignant tumors in children.
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Affiliation(s)
- Hiroki Hirao
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kaori Isono
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku, Shinjuku-ku 160-8582, Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Masaki Honda
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
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Richards MK, Clifton MS. Minimally invasive surgery of the pancreas: a narrative review of current practice. Transl Gastroenterol Hepatol 2021; 6:38. [PMID: 34423159 DOI: 10.21037/tgh-20-220] [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: 05/13/2020] [Accepted: 08/11/2020] [Indexed: 11/06/2022] Open
Abstract
Minimally invasive surgery has moved from the fringe of pediatric surgery to the mainstream to address a variety of problems. Pancreatic pathology, though uncommon and complex, is frequently amenable to laparoscopic intervention. Indications for pediatric pancreatic operative intervention includes trauma, congenital hyperinsulinemia and neoplasm. Children may require distal pancreatectomy, subtotal pancreatectomy, enucleation, lateral pancreaticojejunostomy and pancreaticoduodenectomy. Of these operations, all but pancreaticoduodenectomy have been successfully described in children using a minimally invasive approach. Traumatic transection of the main pancreatic duct may require operative intervention if endoscopic techniques are unsuccessful. Distal pancreatectomy has been successfully utilized in this circumstance. Additionally, near total pancreatectomy may also be performed laparoscopically although successful reports are limited. Enucleation, especially with the use of intraoperative ultrasound may avoid a large laparotomy for isolated benign masses. Finally, chronic pancreatitis resulting in a dilated main pancreatic duct may benefit from a lateral pancreaticojejunostomy. This operation has also successfully been performed in children. Included is a review of pediatric pancreatic minimally invasive operations paired with corresponding pathology.
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Affiliation(s)
- Morgan K Richards
- Division of Pediatric Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew S Clifton
- Division of Pediatric Surgery, Emory University School of Medicine, Atlanta, GA, USA
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4
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Solid pseudo papillary tumor of the pancreas in a 7-year-old girl. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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5
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Systematic Review and Meta-analysis of Minimally Invasive Pancreatectomies for Solid Pseudopapillary Neoplasms of the Pancreas. Pancreas 2019; 48:1334-1342. [PMID: 31688598 DOI: 10.1097/mpa.0000000000001426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We report the first systematic review and meta-analysis on minimally invasive pancreatectomy (MIP) for solid pseudopapillary neoplasms (SPPN) of the pancreas. METHODS A systematic review of all studies reporting patient characteristics and outcomes of MIP for SPPN was conducted. RESULTS We reviewed 27 studies comprising 149 patients with SPPN managed via MIP. Five were comparative retrospective cohort studies, comprising 46 and 60 patients in the minimally-invasive and open groups, respectively. Tumor size was smaller in the minimally-invasive group (mean difference, -2.20; 95% confidence interval (CI), -3.09 to -1.32; P < 0.001). The MI group had lower intraoperative blood loss (mean difference, -180.19; 95% CI, -344.28 to -16.09; P = 0.03) and transfusion requirement (relative risk, 0.24; 95% CI, 0.06-0.94; P = 0.04), and a shorter time to diet (mean difference, -2.99; 95% CI, -3.96 to -2.03; P < 0.001) and length of stay (mean difference, -3.61; 95% CI, -6.98 to -0.24; P = 0.04). There was no significant difference in operating time, margin positivity, postoperative morbidity, and postoperative pancreatic fistula rates. CONCLUSIONS Minimally invasive pancreatectomy for SPPN is associated with decreased intraoperative blood loss and transfusion requirements and a shorter postoperative time to diet and hospital stay.
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Kovler ML, Beckman RM, Goldstein SD, Stewart D. Laparoscopic Spleen-Preserving Distal Pancreatectomy for Solid Pseudopapillary Neoplasm in Adolescents. J Laparoendosc Adv Surg Tech A 2019; 29:1372-1377. [DOI: 10.1089/lap.2019.0201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Mark L. Kovler
- Division of Pediatric General Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ross M. Beckman
- Division of Pediatric General Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Seth D. Goldstein
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Dylan Stewart
- Division of Pediatric General Surgery, Johns Hopkins Hospital, Baltimore, Maryland
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7
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Naar L, Spanomichou DA, Mastoraki A, Smyrniotis V, Arkadopoulos N. Solid Pseudopapillary Neoplasms of the Pancreas: A Surgical and Genetic Enigma. World J Surg 2018; 41:1871-1881. [PMID: 28251269 DOI: 10.1007/s00268-017-3921-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Solid pseudopapillary neoplasms of the pancreas are rare tumors accounting for 1-2% of pancreatic exocrine neoplasms. This entity was first described by Dr. Frantz in 1959 and was defined by the World Health Organization in 1996 as "solid pseudopapillary tumor." It is most often a benign neoplasm, but 10-15% of the cases are malignant. Over the past decades, the incidence of this tumor is increasing. However, many surgeons are still unfamiliar with this neoplasm and its unique characteristics, which can lead to pitfalls in the diagnosis and treatment. The correct diagnosis of SPNP is of utmost importance since it has a low malignant potential and with the appropriate treatment, patients have a long life expectancy. There are many genetic alterations, involving various signaling pathways that have been associated with SPNP and are very important in diagnosing the tumor. The cornerstone of SPNP treatment includes surgical excision of the tumor, preserving as much pancreatic tissue as possible. We review the information in the literature regarding more organ-preserving techniques and possible clinical features that might indicate a malignant potential, thus demanding a more radical intraoperative excision.
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Affiliation(s)
- Leon Naar
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece
| | - Despoina-Amalia Spanomichou
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece
| | - Aikaterini Mastoraki
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece.
| | - Vassilios Smyrniotis
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece
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8
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Retrospective analysis of short term outcomes after spleen-preserving distal pancreatectomy for sodid pseudopapillary tumours. Int J Surg 2015; 21 Suppl 1:S26-9. [PMID: 26118599 DOI: 10.1016/j.ijsu.2015.06.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/19/2015] [Accepted: 04/10/2015] [Indexed: 02/07/2023]
Abstract
Solid pseudopapillary pancreatic tumour (SPN) is a rare pancreatic tumour representing 0.1%-3% of all exocrine pancreatic tumours. Most SPN show benign and low-grade malignant behaviour; malignant degeneration is observed in 10-15% of the patients. More than 40% of SPN involve the tail of the pancreas leading to a minimal invasive distal pancreatectomy approach. In this report we present the case of a young 22 Caucasian woman suffering from SPN who successfully underwent laparoscopic spleen-preserving distal pancreatectomy. Postoperative course was uneventful. A CT scan control at six months was negative for recurrences. We have also made an analysis of all the laparoscopic treatment of SPN reported in English literature.
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9
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Chen XM, Zhang Y, Sun DL. Laparoscopic central pancreatectomy for solid pseudopapillary tumors of the pancreas: our experience with ten cases. World J Surg Oncol 2014; 12:312. [PMID: 25307540 PMCID: PMC4210476 DOI: 10.1186/1477-7819-12-312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 10/01/2014] [Indexed: 02/07/2023] Open
Abstract
Background Solid pseudopapillary tumors (SPTs) of the pancreas are a rare neoplasm. There are few reports of laparoscopic central pancreatectomies (LCPs) for SPT of the pancreas. The objective of this study was to evaluate the feasibility, safety and long-term outcome of LCP based on a series of SPT patients. Methods This retrospective study included ten patients who underwent LCP between 2009 and 2013. Clinical characteristics and intra- and postoperative data were retrospectively analyzed. A follow-up of at least 3 months was available for all patients. Results All procedures were successfully performed laparoscopically, and no patient required intraoperative blood transfusion. The median operative time was 271 min (range 250 to 310 min) and the median loss of blood was 104 ml (range 80 to 150 ml). The mean tumor size was 51 mm (range 38 to 62 mm). All patients underwent complete resection with negative surgical margin. An average of 5.8 lymph nodes were resected without metastases. The median first flatus time was 2 days, and the median starting time for diet was 3 days. The median postoperative hospital stay was 13 days (range 10 to 23 days). Morbidity was 20%. The median follow-up was 22.9 months (range 3 to 48 months), at which point all patients were alive with no recurrence. None of the patients developed exocrine or endocrine insufficiency. No hospital mortalities occurred in our patient group. Conclusions LCP is a safe and effective technique for resecting SPT of the neck and proximal body of the pancreas while preserving pancreatic endocrine and exocrine function, and the spleen.
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Affiliation(s)
- Xue-Min Chen
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China.
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10
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Abstract
Surgery has changed dramatically over the last several decades. The emergence of MIS has allowed pediatric surgeons to manage critically ill neonates, children, and adolescents with improved outcomes in pain, postoperative course, cosmesis, and return to normal activity. Procedures that were once thought to be too difficult to attempt or even contraindicated in pediatric patients in many instances are now the standard of care. New and emerging techniques, such as single-incision laparoscopy, endoscopy-assisted surgery, robotic surgery, and techniques yet to be developed, all hold and reveal the potential for even further advancement in the management of these patients. The future of MIS in pediatrics is exciting; as long as our primary focus remains centered on developing techniques that limit morbidity and maximize positive outcomes for young patients and their families, the possibilities are both promising and infinite.
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Affiliation(s)
- Hope T Jackson
- Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Timothy D Kane
- Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Surgical Residency Training Program, Division of Pediatric Surgery, Department of Surgery, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, 111 Michigan Avenue, Northwest, Washington, DC 20010-2970, USA.
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11
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Senthilnathan P, Patel N, Nalankilli VP, Palanivelu C, Parthasarthi R, Praveenraj P. Laparoscopic pylorus preserving pancreaticoduodenectomy in paediatric age for solid pseudopapillary neoplasm of head of the pancreas - case report. Pancreatology 2014; 14:550-2. [PMID: 25459567 DOI: 10.1016/j.pan.2014.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/22/2014] [Accepted: 06/23/2014] [Indexed: 12/11/2022]
Abstract
Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumour commonly seen in young women without significant clinical features. SPN is usually a lowgrade malignant neoplasm which warrants resection. Recurrence and metastasis is seen rarely after complete resection. Pancreaticoduodenectomy is indicated for SPN situated in head of the pancreas which is generally performed by open approach. Laparoscopic pancreaticoduodenectomy (LPD) is difficult to perform for this condition because of smaller size of pancreatic and hepatic ducts more so in paediatric population. We report a case of 12 years old girl having SPN arising from head of the pancreas. She underwent laparoscopic pylorus preserving pancreaticoduodenectomy. Post-operative period was uneventful. Histological examination of resected specimen confirmed diagnosis of SPN. At 6 months follow up, she was doing well without any recurrence. To best of our knowledge, no case of LPD in paediatric patients is reported in literature available to us.
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Affiliation(s)
| | - Nikunj Patel
- GEM Hospital and Research Centre, Coimbatore, India
| | | | - C Palanivelu
- GEM Hospital and Research Centre, Coimbatore, India
| | | | - P Praveenraj
- GEM Hospital and Research Centre, Coimbatore, India
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12
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Petrosyan M, Franklin AL, Jackson HT, McGue S, Reyes CA, Kane TD. Solid Pancreatic Pseudopapillary Tumor Managed Laparoscopically in Adolescents: A Case Series and Review of the Literature. J Laparoendosc Adv Surg Tech A 2014; 24:440-4. [DOI: 10.1089/lap.2013.0511] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Mikael Petrosyan
- Department of Pediatric Surgery, Children's National Health System, Washington, DC
| | - Ashanti L. Franklin
- Department of Pediatric Surgery, Children's National Health System, Washington, DC
| | - Hope T. Jackson
- Department of Pediatric Surgery, Children's National Health System, Washington, DC
| | - Shannon McGue
- Department of Pediatric Surgery, Children's National Health System, Washington, DC
| | - Christine A. Reyes
- Department of Pathology, Children's National Health System, Washington, DC
| | - Timothy D. Kane
- Department of Pediatric Surgery, Children's National Health System, Washington, DC
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13
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Namgoong JM, Kim DY, Kim SC, Kim SC, Hwang JH, Song KB. Laparoscopic distal pancreatectomy to treat solid pseudopapillary tumors in children: transition from open to laparoscopic approaches in suitable cases. Pediatr Surg Int 2014; 30:259-66. [PMID: 24468715 DOI: 10.1007/s00383-014-3471-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2014] [Indexed: 01/30/2023]
Abstract
PURPOSE The aim of this study was to evaluate the outcomes of open and laparoscopic distal pancreatectomy (LDP) in the treatment of solid pseudopapillary tumors (SPT) in children. METHODS This was a retrospective study of 22 patients under 18 years of age who underwent a distal pancreatectomy for SPT between January 1995 and December 2012. RESULTS Fourteen patients and eight patients underwent LDP and open distal pancreatectomy (ODP), respectively, and 71.4 % of the LDP and 25.0 % of the ODP procedures were spleen-sparing operations. The median duration of surgery in the LDP group was shorter than that in the ODP group [175 (range 120-540) vs. 257 (range 200-305) min, p = 0.024]. There were no differences in postoperative complications. The LDP patients commenced oral intake earlier than the ODP patients [2.0 (range 1.0-7.0) vs. 4.0 (range 3.0-12.0) days, p = 0.010], and had an earlier discharge from hospital [7.0 (range 5.0-20.0) vs. 13.0 (range 7.0-22.0) days, p = 0.009]. CONCLUSION LDP treatment for SPT in children is associated with a shorter hospitalization and a shorter time to oral intake compared to ODP. LDP is a safe and feasible option for SPT in select pediatric patients.
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Affiliation(s)
- Jung-Man Namgoong
- Division of Pediatric Surgery, Department of Surgery, Asan Medical Center, 88, East Building 10th Floor, Olympic-RO 43-GIL, Songpa-gu, Seoul, 138-736, Korea
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14
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Zhang RC, Yan JF, Xu XW, Chen K, Ajoodhea H, Mou YP. Laparoscopic vs open distal pancreatectomy for solid pseudopapillary tumor of the pancreas. World J Gastroenterol 2013; 19:6272-6277. [PMID: 24115826 PMCID: PMC3787359 DOI: 10.3748/wjg.v19.i37.6272] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 07/23/2013] [Accepted: 08/29/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare short- and long-term outcomes of laparoscopic vs open distal pancreatectomy for solid pseudopapillary tumor (SPT) of the pancreas.
METHODS: This retrospective study included 28 patients who underwent distal pancreatectomy for SPT of the pancreas between 1998 and 2012. The patients were divided into two groups based on the surgical approach: the laparoscopic surgery group and the open surgery group. The patients’ demographic data, operative results, pathological reports, hospital courses, morbidity and mortality, and follow-up data were compared between the two groups.
RESULTS: Fifteen patients with SPT of the pancreas underwent laparoscopic distal pancreatectomy (LDP), and 13 underwent open distal pancreatectomy (ODP). Baseline characteristics were similar between the two groups except for a female predominance in the LDP group (100.0% vs 69.2%, P = 0.035). Mortality, morbidity (33.3% vs 38.5%, P = 1.000), pancreatic fistula rates (26.7% vs 30.8%, P = 0.728), and reoperation rates (0.0% vs 7.7%, P = 0.464) were similar in the two groups. There were no significant differences in the operating time (171 min vs 178 min, P = 0.755) between the two groups. The intraoperative blood loss (149 mL vs 580 mL, P = 0.002), transfusion requirement (6.7% vs 46.2%, P = 0.029), first flatus time (1.9 d vs 3.5 d, P = 0.000), diet start time (2.3 d vs 4.9 d, P = 0.000), and postoperative hospital stay (8.1 d vs 12.8 d, P = 0.029) were significantly less in the LDP group than in the ODP group. All patients had negative surgical margins at final pathology. There were no significant differences in number of lymph nodes harvested (4.6 vs 6.4, P = 0.549) between the two groups. The median follow-up was 33 (3-100) mo for the LDP group and 45 (17-127) mo for the ODP group. All patients were alive with one recurrence.
CONCLUSION: LDP for SPT has short-term benefits compared with ODP. Long-term outcomes of LDP are similar to those of ODP.
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Jarry J, Bodin R, Peycru T, Nunez M, Collet D, Cunha AS. Role of laparoscopic distal pancreatectomy for solid pseudopapillary tumor. JSLS 2013; 16:552-8. [PMID: 23484563 PMCID: PMC3558891 DOI: 10.4293/108680812x13462882736970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Since the first case report regarding laparoscopic distal pancreatectomy (DP) for solid pseudopapillary tumor (SPT), few additional articles have been published. The objective of this study was to evaluate the feasibility, safety, and long-term outcome of the laparoscopic DP based on a series of adult SPT patients. METHODS In a single-center study, we screened all adult patients undergoing a laparoscopic DP for SPT. Preoperative, operative, and postoperative data were retrospectively analysed and compared to the results of open DP for SPT published in the medical literature. RESULTS From April 2000 to June 2010, 5 adult female patients (median age 34 y) underwent a laparoscopic DP for an SPT. No conversion to open surgery was required. The median size of the tumor was 45 mm. The postoperative mortality rate was 0%, and serious complications (Dindo IV) occurred in 2 patients. The postoperative quality of life was not significantly altered by the laparoscopic procedure. At a median follow-up of 60 mo, all patients were alive and without evidence of local recurrence, distant metastasis, diabetes, or exocrine insufficiency. CONCLUSION Laparoscopy may offer an alternative to open surgery in the treatment of SPT of the distal pancreas in adult female patients. The laparoscopic procedure impacts neither the oncologic outcome nor the quality of life. However, due to the risk of postoperative complications, this procedure should be reserved for specialized centers.
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Affiliation(s)
- Julien Jarry
- Department of Digestive Surgery, Robert Picqué Hospital, Villenave d'Ornon, France.
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Rojas Y, Warneke CL, Dhamne CA, Tsao K, Nuchtern JG, Lally KP, Vasudevan SA, Hayes-Jordan AA, Cass DL, Herzog CE, Hicks MJ, Kim ES, Austin MT. Primary malignant pancreatic neoplasms in children and adolescents: a 20 year experience. J Pediatr Surg 2012; 47:2199-204. [PMID: 23217876 DOI: 10.1016/j.jpedsurg.2012.09.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 09/01/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Malignant pancreatic neoplasms in children and adolescents are rare. The clinical presentation, pathologic characteristics, management, and outcomes at two institutions are discussed. METHODS We retrospectively reviewed all pediatric patients (age <= 18 years) treated for malignant pancreatic neoplasms at two institutions between 1991 and 2011. RESULTS Thirty-one patients were identified with median age of 14.7 years (4-18 years). The most common histology was solid pseudopapillary tumor (SPT) (n=22, 71%) followed by neuroendocrine tumors (n=4, 13%), pancreatoblastoma (n=4, 13%), and one unclassified spindle cell neoplasm (3%). Most patients presented with abdominal pain (n=22, 71%). Complications included pancreatic leak, pseudocyst formation, pancreatitis, pancreatic insufficiency, and small bowel obstruction. The overall 1- and 5-year survival was 96% (95% CI 74%-99%) and 78% (95% CI 43%-93%). Median follow-up among patients alive at the end of follow-up was 20 months (<1 month-16.2 years). Patients with SPT had better overall survival compared to patients with neuroendocrine tumors or pancreatoblastomas (Log-rank; p=0.0143). CONCLUSION The majority of pediatric and adolescent patients present with SPTs which are usually resectable and associated with an excellent prognosis. Other histologic subtypes more often present with distant metastases and portend a worse prognosis.
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Affiliation(s)
- Yesenia Rojas
- Department of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Abstract
The pseudopapillary tumor of the pancreas (or Frantz's tumor) is a rare exocrine pancreatic tumor with a low degree of malignancy. It occurs more frequently among women between 20 and 40 years of age and in the Asian population. This tumor is rarer in the pediatric population. The symptoms are subtle, the most striking being pain and an abdominal mass. Pathologically, the tumor is usually well circumscribed with regions of necrosis, hemorrhage and cystic degeneration. A thick, fibrous capsule is often present. The low grade of malignancy of this tumor with a fibrous capsule led to perform a surgical resection. The localization and local invasion determine the surgical technique. Despite its potential for local infiltration and metastatic disease (up to 15% confined often to the liver), the prognosis is favorable after a surgical resection with correct margins. Long follow-up is necessary to detect a possible recurrence, even late.
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18
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Tsai FJ, Lee JY, Chang YT. Laparoscopic Resection of a Giant Solid Pseudopapillary Neoplasm of Uncinate Process of the Pancreas in a Child. J Laparoendosc Adv Surg Tech A 2011; 21:979-82. [DOI: 10.1089/lap.2011.0102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Feng-Ji Tsai
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jui-Ying Lee
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Tang Chang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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19
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Horiguchi A, Uyama I, Miyakawa S. Robot-assisted laparoscopic pancreaticoduodenectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 18:287-91. [PMID: 20811915 DOI: 10.1007/s00534-010-0325-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Robotic surgery is the most advanced development in minimally invasive surgery. However, the number of reports on robot-assisted endoscopic gastrointestinal surgery is still very small. In this article, we describe total laparoscopic pancreaticoduodenectomy (PD) undertaken using the da Vinci Surgical System® (Intutive Surgical). METHODS Three patients underwent robotic PD between November 2009 and February 2010. Following resection of the pancreatic head, duodenum, and the distal stomach, intracorporeal anastomosis was accomplished by Child's method of reconstruction, which includes a two-layered end-to-side pancreaticojejunostomy, an end-to-side choledochojejunostomy, and a side-to-side gastrojejunostomy. RESULTS The time required for surgery was 703 ± 141 min, and blood loss was 118 ± 72 mL. The average hospital stay period was 26 ± 12 days. As a postoperative complication, pancreatic juice leak occurred in one case, but it was managed with conservative treatment. Of the three patients, one had cancer of the papilla of Vater, one had cancer of the pancreatic head, and one had a solid pseudopapillary neoplasm. In all cases, the surgical margin was negative for tumor. CONCLUSIONS Robot-assisted PD required a long time, but organ removal with less bleeding was able to be safely performed owing to the high degree of freedom associated with the forceps manipulation and the magnified view. Similarly, pancreatojejunostomy could certainly be conducted. No major postoperative complications were found. Accumulation of da Vinci PD experience in the future will lead to safer and faster PD.
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Affiliation(s)
- A Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University, Toyoake, Aichi, Japan.
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20
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Marinis A, Anastasopoulos G, Polymeneas G. A solid pseudopapillary tumor of the pancreas treated with laparoscopic distal pancreatectomy and splenectomy: a case report and review of the literature. J Med Case Rep 2010; 4:387. [PMID: 21114814 PMCID: PMC3000418 DOI: 10.1186/1752-1947-4-387] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Accepted: 11/29/2010] [Indexed: 12/22/2022] Open
Abstract
Introduction Laparoscopic distal pancreatectomy has been described for more than a decade now and has been considered technically feasible, safe, and with reproducible outcomes. It seems to exhibit several benefits of minimally invasive surgery and should be performed in carefully selected patients. Case presentation We report the case of a 55-year-old Greek woman with a solid pseudopapillary tumor of the tail of the pancreas. She underwent a laparoscopic distal pancreatectomy and splenectomy. The histopathologic examination finally revealed a cystic-solid pseudopapillary neoplasm of the pancreas. Solid pseudopapillary tumors of the pancreas are rare and affect predominantly young women. These tumors are of unclear pathogenesis and low malignancy, and surgical resection offers an excellent chance for long-term survival. Conclusion This case report indicates that in selected centers and for selected patients, laparoscopic distal pancreatectomy is feasible. The benign characteristics of these tumors make them ideal for laparoscopic excision.
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Affiliation(s)
- Athanasios Marinis
- Second Department of Surgery, Aretaieion University Hospital, 76 Vassilisis, Sofia's Ave, 11528, Athens, Greece.
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21
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Uchida H, Goto C, Kishimoto H, Kawashima H, Sato K, Yoshida M, Takazawa S. Laparoscopic spleen-preserving distal pancreatectomy for solid pseudopapillary tumor with conservation of splenic vessels in a child. J Pediatr Surg 2010; 45:1525-9. [PMID: 20638537 DOI: 10.1016/j.jpedsurg.2010.03.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 03/09/2010] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
Abstract
Laparoscopic spleen-preserving distal pancreatectomy (LSDP) with conservation of the splenic vessels is gaining acceptance as a reliable treatment for selected patients with low-grade malignant tumors of the pancreas in adults. The operation requires advanced laparoscopic skills to safely divide the fine branches of the splenic vessels. Laparoscopic spleen-preserving distal pancreatectomy with conservation of splenic vessels is rarely reported in children. We describe a 12-year-old girl with solid pseudopapillary tumor in the body of the pancreas that was successfully treated with LSDP, preserving the splenic vessels. The postoperative course was uneventful, and the functional and aesthetic results were satisfactory. Laparoscopic spleen-preserving distal pancreatectomy with conservation of splenic vessels may be a safe and feasible treatment option for children with pancreatic disease.
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Affiliation(s)
- Hiroo Uchida
- Department of Pediatric Surgery, Saitama Children's Medical Center, Iwatsuki, Saitama, Saitama 339-8551, Japan.
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22
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Mukherjee K, Morrow SE, Yang EY. Laparoscopic Distal Pancreatectomy in Children: Four Cases and Review of the Literature. J Laparoendosc Adv Surg Tech A 2010; 20:373-7. [DOI: 10.1089/lap.2009.0247] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kaushik Mukherjee
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Stephen E. Morrow
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Edmund Y. Yang
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center at St. Louis University, St. Louis, Missouri
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Fais PO, Carricaburu E, Sarnacki S, Berrebi D, Orbach D, Baudoin V, de Lagausie P. Is laparoscopic management suitable for solid pseudo-papillary tumors of the pancreas? Pediatr Surg Int 2009; 25:617-21. [PMID: 19479267 DOI: 10.1007/s00383-009-2388-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2009] [Indexed: 01/27/2023]
Abstract
PURPOSE Solid pseudo-papillary tumors (SPT) are rare pancreatic neoplasms of low-malignant potential occurring mainly in young women. The purpose of this report is to describe our experience with laparoscopic management of these tumors with 4-year follow-up. METHODS Three children with SPT were admitted to two hospitals in Paris, France, between February 2000 and December 2006. Diagnosis or treatment was carried out using laparoscopic techniques (biopsy and resection in one case and biopsy only in two). Long-term follow-up data were collected. RESULTS All three patients presented recurrences within 3 years after resection, i.e., disseminated peritoneal recurrence in two patients and local recurrence in one. The two patients with peritoneal recurrences were treated by surgical resection and chemotherapy. The patient with local recurrence could not be treated due to contraindicating local factors. All three patients were alive at the time of this writing. CONCLUSION This is the first report describing long-term follow-up after laparoscopic management of SPT. All three patients developed recurrences. These poor results contrast sharply with the low risk of local or disseminated recurrence after open laparotomy without chemotherapy that has been considered as the treatment of choice up to now. Recurrences after laparoscopic management may have been due to diffusion of tumor cells caused by gas insufflation especially during biopsy. Laparoscopic biopsy should not be performed in patients presenting SPT.
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Affiliation(s)
- P O Fais
- Department of Pediatric Surgery, Timone Enfants Hospital, 264 Bld Saint Pierre, 13385 Marseille Cedex 05, France
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24
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Laparoscopic vs open pancreatectomy for persistent hyperinsulinemic hypoglycemia of infancy. J Pediatr Surg 2009; 44:957-61. [PMID: 19433178 DOI: 10.1016/j.jpedsurg.2009.01.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 01/15/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is considered the most common cause of persistent neonatal hypoglycemia. The aim of this study is to compare laparoscopic pancreatectomy with open pancreatectomy for PHHI in one center regarding feasibility, safety, and effectiveness. METHODS A retrospective chart review was conducted for patients managed for PHHI with either laparoscopic or open pancreatectomy for the period from 2001 to 2007 at King Faisal Specialist Hospital and Research Center (Riyadh, Saudi Arabia). Demographic and clinical data were retrieved. Continuous variables were reported as means, and categorical variables were reported as proportions for each group. Means were compared using Student's t test, and proportions were compared using chi(2) test or Fisher's Exact test where appropriate. A P value less than .05 was considered statistically significant. The study proposal was approved by the Clinical Research Committee and the Research Ethics Committee at our institution. RESULTS Eighteen patients were managed with pancreatectomy for PHHI for that period: 10 laparoscopic and 8 open. The 2 groups were comparable regarding age and weight at surgery, sex, procedure duration, hospital stay postoperatively, need for reoperation, and development of diabetes mellitus and mental delay. Extent of resection was significantly higher in the open group (P value = .02), and the laparoscopic group was fed significantly earlier (P value = .001). The mean follow-up for the laparoscopic and the open groups were 20.4 months and 46 months, respectively (P value = .004). CONCLUSIONS Laparoscopic pancreatectomy for PHHI is safe and feasible. Our data suggest its effectiveness compared to the open approach.
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25
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Laparoscopic resection of uncinate process of the pancreas. Surg Endosc 2009; 23:1391-2. [PMID: 19263119 DOI: 10.1007/s00464-009-0390-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 12/11/2008] [Accepted: 01/12/2009] [Indexed: 12/15/2022]
Abstract
BACKGROUND Solid pseudopapillary neoplasm of the pancreas is an uncommon but distinctive pancreatic neoplasm with low metastatic potential [1]. Therefore, whenever feasible, an organ-preserving operation should be performed. As previously reported, women with solid pseudopapillary neoplasm of the pancreas may be best treated by more conservative procedures [2]. Recently, laparoscopic pancreatic resections became more common and are being performed in highly specialized centers. There are only six cases of laparoscopic resection for solid pseudopapillary neoplasm of pancreas published in the English literature and, to our knowledge, laparoscopic resection of uncinate process of the pancreas has never been reported [3-6]. This video demonstrates the technical aspects of a totally laparoscopic resection of the uncinate process of the pancreas in a patient with solid pseudopapillary neoplasm. METHODS A 26-year-old woman with a 4-cm solid pseudopapillary pancreatic neoplasm was referred for surgical treatment. According to preoperative echoendoscopy, there was a safe margin between neoplasm and main pancreatic duct. The patient was placed in supine position with the surgeon standing between her legs. Four trocars, one 10-mm and three 5-mm, were used. At inspection, the inferior vena cava, transverse colon, duodenum, and pancreas are clearly identified. A Kocher maneuver was performed with complete exposure of pancreatic head and uncinate process. The uncinate process was dissected from the superior mesenteric vein and venous branches were divided between metallic clips or by use of laparoscopic coagulation shears (LCS; Ethicon Endo Surgery Industries, Cincinnati, OH, USA). Blood supply of the duodenum was preserved by ligature of small pancreatic branches from inferior pancreatoduodenal artery. Transection of pancreatic parenchyma was performed using laparoscopic coagulation shears, which is an effective tool for cutting the pancreas [7, 8]. Surgical specimen was removed through a suprapubic incision inside a retrieval bag. A hemostatic absorbable tissue (Surgicel; Ethicon Inc., Cincinnati, OH) was placed in the cutting pancreatic surface, and one round 19F Blake abdominal drain (Ethicon) was left in place. RESULTS Operative time was 180 minutes and blood loss estimated in 40 ml with no blood transfusion. Hospital stay was 4 days. The patient did not have postoperative pancreatitis or pancreatic leakage, and the abdominal drain was removed on the tenth postoperative day. Final pathology confirmed the diagnosis of solid pseudopapillary neoplasm of pancreas with free surgical margins. The patient was well and asymptomatic 2 months after the procedure. CONCLUSIONS Laparoscopic resection of uncinate process of the pancreas is safe and feasible and should be considered for patients suffering from pancreatic neoplasms.
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26
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Al-Shanafey S, Habib Z, AlNassar S. Laparoscopic pancreatectomy for persistent hyperinsulinemic hypoglycemia of infancy. J Pediatr Surg 2009; 44:134-8; discussion 138. [PMID: 19159730 DOI: 10.1016/j.jpedsurg.2008.10.120] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 10/07/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is considered the most common cause of persistent neonatal hypoglycemia. Management of PHHI involves use of medical agents and its failure is an indication of surgical intervention. Traditionally, an open pancreatectomy was the standard of care but recently laparoscopic pancreatectomy was described. We report our experience with laparoscopic pancreatectomy for PHHI for the period from March 2004 to February 2008. METHODS A retrospective chart review was conducted for patients managed for PHHI with laparoscopic pancreatectomy for that period. Demographic and clinical data were retrieved. Descriptive data were generated, and SPSS version 10 statistical package (SPSS, Chicago, Ill) was used. RESULTS Twelve patients diagnosed with PHHI were managed with laparoscopic pancreatectomy for that period. Median age at procedure was 11.5 months (range, 0.5-89 months). Median extent of pancreatectomy was 90% (range, 85%-95%). There were 2 (16%) conversions to open technique. One patient (8%) required reoperation 3 months after the procedure. Patients were followed up for a median of 23.5 months (range, 3-48 months). Four (33%) were euglycemic with no medications. Three patients remained on octreotide postoperatively to be euglycemic, and 3 patients needed a combination of octreotide and diazoxide. One patient remained euglycemic for 10 months then started on octreotide because of recurrence of hypoglycemia. One patient remained hypoglycemic postoperatively and required reoperation 3 months later to control symptoms. He became diabetic 4 months after reoperation on insulin. CONCLUSIONS Our data suggest that laparoscopic pancreatectomy for medically unresponsive PHHI is feasible and safe. Longer follow-up is needed to ascertain effectiveness.
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Affiliation(s)
- Saud Al-Shanafey
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
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27
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Kang CM, Yang WI, Lee YH, Choi GH, Lee SW, Kim KS, Choi JS, Lee WJ, Kim BR. A Case of Spleen-Preserving Laparoscopic Distal Pancreatectomy and Concomitant Cholecystectomy in Male Patient with Solid Pseudopapillary Neoplasm of the Pancreas and Gallstone. J Laparoendosc Adv Surg Tech A 2008; 18:259-65. [DOI: 10.1089/lap.2007.0022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chang Moo Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Woo Ick Yang
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Lee
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Gi Hong Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Sung Whan Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Jin Sub Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Woo Jung Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Byong Ro Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
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Takaori K, Tanigawa N. Laparoscopic pancreatic resection: the past, present, and future. Surg Today 2007; 37:535-45. [PMID: 17593471 DOI: 10.1007/s00595-007-3472-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 01/11/2007] [Indexed: 02/06/2023]
Abstract
Since the early 1990s, laparoscopic techniques have been applied to a growing number of pancreatic surgeries. Laparoscopic pancreatic resections have been performed in patients with a variety of diseases including chronic pancreatitis, pancreatic trauma, congenital hyperinsulinism, and neoplasms of the pancreas; e.g., insulinoma, mucinous cystic neoplasm, intraductal papillary mucinous neoplasm, etc. Laparoscopic pancreatic resections with an en bloc lymph node dissection have also been performed for invasive carcinomas. The long-term results after laparoscopic resections for invasive pancreatic cancer, however, are still not well defined. Laparoscopic distal pancreatectomies with or without spleen preservation may benefit patients with reduced postoperative pain, shorter hospital stay, a quicker recovery to normal activity, and better cosmetic appearances based on retrospective analyses of collective series and case reports. Prospective randomized controlled trials are needed to validate these benefits. In contrast, laparoscopic proximal pancreatectomies with or without duodenum preservation remain controversial. Although a laparoscopic pancreaticoduodenectomy and laparoscopic duodenum-preserving pancreatic head resection are technically feasible, laparoscopic reconstruction after proximal pancreatectomies is not yet generally practicable but limited to personal experiences by highly skilled endoscopic surgeons. To justify the performance of laparoscopic proximal pancreatectomies, it is mandatory to demonstrate the potential clinical benefits and safety of these complicated procedures.
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Affiliation(s)
- Kyoichi Takaori
- Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
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Liu X, Rauch TM, Siegal GP, Jhala N. Solid-pseudopapillary neoplasm of the pancreas: Three cases with a literature review. Appl Immunohistochem Mol Morphol 2007; 14:445-53. [PMID: 17122644 DOI: 10.1097/01.pai.0000194763.86513.e4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Solid-pseudopapillary neoplasm of the pancreas is a very rare tumor. It most commonly occurs in young women and has unique pathologic features. Previous immunohistochemical studies demonstrated that most solid-pseudopapillary neoplasms were immunoreactive with antibodies directed against vimentin and neuron-specific enolase. Recently, expression of CD10 and CD56 in this tumor has been reported. In this report, we expanded the demographic profile, highlighting 3 cases of solid-pseudopapillary neoplasm of the pancreas that presented in an elderly woman, a young man, and a young woman and further characterized them histologically and immunophenotypically. Grossly, all 3 tumors were well circumscribed and had a variable degree of cystic formation, necrosis, and hemorrhage. Microscopically, these tumors were characterized by a pseudopapillary pattern of epithelioid cells arranged around a delicate fibrovascular core with sheets of bland epithelioid cells filling cystic spaces. Hyaline globules, cholesterol granulomas, and foamy cells were all seen to be common findings. Although these 3 tumors were strongly immunoreactive for vimentin, alpha-1-antitrypsin, alpha-1-antichymotrypsin, neuron-specific enolase, CD10, CD56, and progesterone receptor, they demonstrated only variable "positivity" for epithelial membrane antigen and broad-spectrum cytokeratin, but were being consistently nonreactive for synaptophysin, insulin, glucogon, chromogranin A, and estrogen receptor. Interestingly, 2 of the 3 tumors were S-100 protein and melanin A reactive but were nonreactive for HMB45.
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Affiliation(s)
- Xiuli Liu
- Division of Anatomic Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
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30
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Aluka KJ, Long C, Rickford MS, Turner PL, McKenna SJ, Fullum TM. Laparoscopic distal pancreatectomy with splenic preservation for serous cystadenoma: a case report and literature review. Surg Innov 2007; 13:94-101. [PMID: 17012149 DOI: 10.1177/1553350606291339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A minimally invasive approach can be beneficial in a spleen-preserving distal pancreatectomy. This article reports a 71-year-old woman who presented to her internist with hypertension and persistent hypokalemia. A computed tomography scan to rule out a functional adrenal mass incidentally revealed a 4 cm x 3 cm x 2 cm serous cystadenoma of the distal pancreas and normal adrenal glands. The patient was referred to the general surgery service for resection of the distal pancreatic lesion. A laparoscopic spleen-preserving distal pancreatectomy was performed. The lesion was completely excised, and the pathology revealed serous cystadenoma with focal fibrosis and atrophic acini. The postoperative advantages of this approach were the early return of bowel function, minimal narcotic requirements, and early resumption of normal activities. This case illustrates the advantages of minimally invasive surgery in the performance of a spleen-preserving distal pancreatectomy.
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Affiliation(s)
- Kanayochukwu J Aluka
- Department of Surgery, Providence Hospital, Washington, District of Columbia, USA.
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31
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Melotti G, Cavallini A, Butturini G, Piccoli M, Delvecchio A, Salvi C, Pederzoli P. Laparoscopic Distal Pancreatectomy in Children: Case Report and Review of the Literature. Ann Surg Oncol 2007; 14:1065-9. [PMID: 17206487 DOI: 10.1245/s10434-006-9133-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Revised: 06/08/2006] [Accepted: 06/14/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Laparoscopic resection of benign tumors of the pancreas has been reported in adults, but only four cases of partial laparoscopic pancreatectomy in children have been described in the English-language literature. METHODS We describe the case of an 11-year-old girl with a solid pseudopapillary tumor who was treated with a laparoscopic, spleen-preserving, distal pancreatectomy. The specimen was extracted in an endoscopic bag retrieval system through a Pfannenstiel incision. Operative time was 120 minutes, and minimal blood loss occurred. The literature is reviewed. RESULTS The postoperative course was uneventful. Twenty-two months after the operation, clinical follow-up (including assessment of exocrine and endocrine pancreatic function) revealed nothing abnormal. The functional and aesthetic results were satisfactory. CONCLUSIONS The technique used for our case is simple and reproducible, was completed safely within a reasonable operative time, and yielded a good result.
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Choi SH, Kim SM, Oh JT, Park JY, Seo JM, Lee SK. Solid pseudopapillary tumor of the pancreas: a multicenter study of 23 pediatric cases. J Pediatr Surg 2006; 41:1992-5. [PMID: 17161189 DOI: 10.1016/j.jpedsurg.2006.08.024] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND/PURPOSE Solid pseudopapillary tumor (SPT) is a very rare form of childhood pancreatic tumor. This study was intended to analyze the clinicopathologic characteristics of this tumor in childhood. METHODS We retrospectively reviewed the medical records of patients who were pathologically diagnosed with SPT between March 1991 and March 2005. RESULTS Twenty-three patients underwent an operation and were pathologically diagnosed with SPT. Five (22%) were male, with a male-to-female ratio of 1:3.6. The initial signs and symptoms were upper abdominal pain in 20 patients (87%), palpable abdominal mass in 8 (35%), and dyspepsia in 6 (26%). Four patients (17%) had a history of abdominal trauma. Tumors were located in the pancreatic head (30%), body (13%), tail (44%), and both body and tail (13%). Operative procedures performed were pylorus-preserving pancreaticoduodenectomy (n = 6, 26.1%), distal pancreatectomy (n = 7, 30.4%), distal pancreatectomy with splenectomy (n = 7, 30.4%). The median follow-up period was 62 months (range, 6-175 months). One patient showed multiple liver metastasis 3 months after the initial operation and required adjuvant chemotherapy. All other patients were alive at their most recent follow-up with no evidence of recurrence or distant metastasis. CONCLUSIONS Complete resection of an SPT is usually curative and patients can survive a long period after the operation.
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Affiliation(s)
- Seung Hoon Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, South Korea.
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Abstract
Laparpscopic Surgery/Minimally Invasive Surgery (MIS) in children have witnessed tremendous progress in the last decade. Presently, there are extensive applications of this novel technique and several advanced level intricate surgeries have been done safely in small children. This is a brief overview of the common indications and utility of MIS in pediatric practice in the Indian Scenario. We discuss some common clinical settings like recurrent abdominal pain, Impalpable testis, intersex disorders Empyema, Thoracis etc., where MIS has had a significant benefit. We also present our experience of MIS in children without using any sophisticated equipment like the harmonic scalpel, endo-staplers etc. MIS has come to stay and it will definitely have lasting impact on surgical problems in children.
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Affiliation(s)
- K R Srimurthy
- Indira Gandhi Institute of Child Health & Bangalore Hospital, Bangalore, India
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