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Ninomiya R, Komagome M, Abe S, Maruta S, Matsudaira S, Okada N, Mori K, Nagata R, Chiyoda T, Kimura A, Takemura N, Maki A, Beck Y, Hsieh CL, Peng CM. Reduced-port robotic pancreaticoduodenectomy with optimized surgical field deployment: early results of single-site plus-two ports method. Surg Endosc 2024; 38:5422-5429. [PMID: 39048737 PMCID: PMC11362361 DOI: 10.1007/s00464-024-11097-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: 03/04/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND The adoption of Robotic Pancreaticoduodenectomy (RPD) is increasing globally. Meanwhile, reduced-port RPD (RPRPD) remains uncommon, requiring robot-specific techniques not possible with laparoscopy. We introduce a unique RPRPD technique optimizing surgical field exposure. METHODS Our RPRPD utilizes a single-site plus-two ports technique, facilitated by a single-port platform through a 5-cm incision. The configuration of robotic arms (arm1, arm2, arm3, and arm4) were strategically designed for optimal procedural efficiency, with the arms2 and arm3, alongside the assistant trocar, mounted on the single-port platform, while the arms1 and arm4 were positioned laterally across the abdomen. Drainage was established via channels created at the arm1 and arm4 insertion sites. A "gooseneck traction" was principally employed with the robotic instrument to prop up the specimen rather than grasp, improving the surgical field's visibility and access. Clinical outcomes of patients who underwent RPRPD performed between August 2020 and September 2023 by a single surgeon across two centers in Taiwan and Japan were reviewed. RESULTS Fifty patients underwent RPRPD using the single-site plus-two ports technique. The gooseneck traction technique enabled goodsurgical field deployment and allowed for unrestricted movement of robotic arms with no collisions with the assistant instruments. The median operative time was 351 min (250-488 min), including 271 min (219-422 min) of console time and three minutes (2-10 min) of docking time. The median estimated blood loss was 80 mL (1-872 mL). All RPRPD procedures were successfully performed without the need for conversion to open surgery. Postoperative major morbidity (i.e., Clavien-Dindo grade ≥ IIIa) was observed in 6 (12%) patients and median postoperative hospital stay was 13 days. CONCLUSIONS The single-site plus-two ports RPRPD with the gooseneck traction proves to be a safe, feasible option, facilitating surgical field visibility and robotic arm maneuverability.
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Affiliation(s)
- Riki Ninomiya
- Department of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan.
| | - Masahiko Komagome
- Department of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Satoru Abe
- Hepato-Biliary-Pancreatic Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shohei Maruta
- Department of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Shinichi Matsudaira
- Department of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Noriki Okada
- Department of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Kazuhiro Mori
- Department of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Rihito Nagata
- Department of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Takehiro Chiyoda
- Hepato-Biliary-Pancreatic Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akifumi Kimura
- Department of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Nobuyuki Takemura
- Department of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Akira Maki
- Department of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Yoshifumi Beck
- Department of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Ching-Lung Hsieh
- Da Vinci Minimally Invasive Surgery Center, Chung Shan Medical University Hospital, No.110, Sec 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan
| | - Cheng-Ming Peng
- Da Vinci Minimally Invasive Surgery Center, Chung Shan Medical University Hospital, No.110, Sec 1, Chien-Kuo N. Rd., Taichung, 40201, Taiwan
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Zhun Hong Wong N, Wei Ting Yap D, Lei Ng S, Yu Ning Ng J, James JJ, Wei Chieh Kow A. Oncological outcomes in minimally invasive vs. open distal pancreatectomy: a systematic review and network meta-analysis. Front Surg 2024; 11:1369169. [PMID: 38933652 PMCID: PMC11203400 DOI: 10.3389/fsurg.2024.1369169] [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: 01/11/2024] [Accepted: 05/08/2024] [Indexed: 06/28/2024] Open
Abstract
Background Advancements in surgical techniques have improved outcomes in patients undergoing pancreatic surgery. To date there have been no meta-analyses comparing robotic and laparoscopic approaches for distal pancreatectomies (DP) in patients with pancreatic adenocarcinoma (PDAC). This systematic review and network meta-analysis aims to explore the oncological outcomes of laparoscopic distal pancreatectomy (LDP), robotic distal pancreatectomy (RDP) and open distal pancreatectomy (ODP). Methods A systematic search was conducted for studies reporting laparoscopic, robotic or open surgery for DP. Frequentist network meta-analysis of oncological outcomes (overall survival, resection margins, tumor recurrence, examined lymph nodes, administration of adjuvant therapy) were performed. Results Fifteen studies totalling 9,301 patients were included in the network meta-analysis. 1,946, 605 and 6,750 patients underwent LDP, RDP and ODP respectively. LDP (HR: 0.761, 95% CI: 0.642-0.901, p = 0.002) and RDP (HR: 0.757, 95% CI: 0.617-0.928, p = 0.008) were associated with overall survival (OS) benefit when compared to ODP. LDP (HR: 1.00, 95% CI: 0.793-1.27, p = 0.968) was not associated with OS benefit when compared to RDP. There were no significant differences between LDP, RDP and ODP for resection margins, tumor recurrence, examined lymph nodes and administration of adjuvant therapy. Conclusion This study highlights the longer OS in both LDP and RDP when compared to ODP for patients with PDAC. Systematic Review Registration https://www.crd.york.ac.uk/, PROSPERO (CRD42022336417).
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Affiliation(s)
- Nicky Zhun Hong Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dominic Wei Ting Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sherryl Lei Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Junie Yu Ning Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Juanita Jaslin James
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alfred Wei Chieh Kow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Hospital Singapore, Singapore, Singapore
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Wu M, Lin Y, Wei J. A commentary on 'Learning curves in laparoscopic distal pancreatectomy: a different experience for each generation (Int J Surg. 2023;109(6):1648-55)'. Int J Surg 2023; 109:3707-3708. [PMID: 37549054 PMCID: PMC10651237 DOI: 10.1097/js9.0000000000000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 08/09/2023]
Affiliation(s)
| | | | - Jianfeng Wei
- Hepatobiliary Surgery Department, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, People’s Republic of China
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Comparative Efficacy of Robot-Assisted and Laparoscopic Distal Pancreatectomy: A Single-Center Comparative Study. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7302222. [PMID: 35024102 PMCID: PMC8747902 DOI: 10.1155/2022/7302222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 01/08/2023]
Abstract
Background Laparoscopic distal pancreatectomy (LDP) has become a routine procedure in pancreatic surgery. Although robotic distal pancreatectomy (RDP) has not been popularized yet, it has shown new advantages in some aspects, and exploring its learning curve is of great significance for guiding clinical practice. Methods 149 patients who received RDP and LDP in our surgical team were enrolled in this retrospective study. Patients were divided into two groups including LDP group and RDP group. The perioperative outcomes, histopathologic results, long-term postoperative complications, and economic cost were collected and compared between the two groups. The cumulative summation (CUSUM) analysis was used to explore the learning curve of RDP. Results The hospital stay, postoperative first exhaust time, and first feeding time in the RDP group were better than those in the LDP group (P < 0.05). The rate of spleen preservation in patients with benign and low-grade tumors in the RDP group was significantly higher than that of the LDP group (P=0.002), though the cost of operation and hospitalization was significantly higher (P < 0.001). The learning curve of RDP in our center declined significantly with completing 32 cases. The average operation time, the hospital stay, and the time of gastrointestinal recovery were shorter after the learning curve node than before. Conclusion RDP provides better postoperative recovery and is not difficult to replicate, but the high cost was still a major disadvantage of RDP.
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Kurakawa KI, Okada A, Manaka K, Konishi T, Jo T, Ono S, Uda K, Michihata N, Matsui H, Fushimi K, Yamaguchi S, Yamauchi T, Nangaku M, Yasunaga H, Kadowaki T. Clinical Characteristics and Incidences of Benign and Malignant Insulinoma Using a National Inpatient Database in Japan. J Clin Endocrinol Metab 2021; 106:3477-3486. [PMID: 34343300 DOI: 10.1210/clinem/dgab559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Insulinoma is the most common pancreatic functional neuroendocrine neoplasm, yet little information on recent clinical practice in patients with insulinoma, especially malignant insulinoma, is available. OBJECTIVE This work aims to clarify the characteristics and practice patterns in patients with insulinoma using a national inpatient database. METHODS Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified patients with insulinoma admitted between 2010 and 2018. We compared background characteristics and therapeutic interventions between patients with benign and malignant insulinoma. We also estimated the incidence of insulinoma using the number of patients with newly diagnosed insulinoma in 2012. RESULTS We identified 844 patients with benign insulinoma and 102 patients with malignant insulinoma. Patients with malignant insulinoma were younger (median, 55.5 vs 66.0 years, P < .001) and less likely to be female (55.9% vs 65.3%, P = .061) than patients with benign insulinoma. Analysis of therapeutic interventions revealed that patients with malignant insulinoma more frequently received medications (71.6% vs 49.6%, P < .001) but less frequently underwent pancreatic surgery (57.8% vs 72.0%, P = .003). Older patients were a smaller proportion of those undergoing surgery and a larger proportion of those managed with medications without surgery (P < .001). The incidence of insulinoma was estimated to be 3.27 (95% CI, 2.93-3.61) individuals per million Japanese adult population per year. CONCLUSION The present study using a nationwide database had a larger sample size than previous studies and revealed definitive differences in patient characteristics and therapeutic patterns between benign and malignant insulinoma.
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Affiliation(s)
- Kayo Ikeda Kurakawa
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Katsunori Manaka
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Sachiko Ono
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kazuaki Uda
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo 113-8510, Japan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
- Toranomon Hospital, Tokyo 105-8470, Japan
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Robotic versus Laparoscopic Surgery for Spleen-Preserving Distal Pancreatectomies: Systematic Review and Meta-Analysis. J Pers Med 2021; 11:jpm11060552. [PMID: 34199314 PMCID: PMC8231987 DOI: 10.3390/jpm11060552] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/03/2021] [Accepted: 06/09/2021] [Indexed: 12/29/2022] Open
Abstract
Background: When oncologically feasible, avoiding unnecessary splenectomies prevents patients who are undergoing distal pancreatectomy (DP) from facing significant thromboembolic and infective risks. Methods: A systematic search of MEDLINE, Embase, and Web Of Science identified 11 studies reporting outcomes of 323 patients undergoing intended spleen-preserving minimally invasive robotic DP (SP-RADP) and 362 laparoscopic DP (SP-LADP) in order to compare the spleen preservation rates of the two techniques. The risk of bias was evaluated according to the Newcastle–Ottawa Scale. Results: SP-RADP showed superior results over the laparoscopic approach, with an inferior spleen preservation failure risk difference (RD) of 0.24 (95% CI 0.15, 0.33), reduced open conversion rate (RD of −0.05 (95% CI −0.09, −0.01)), reduced blood loss (mean difference of −138 mL (95% CI −205, −71)), and mean difference in hospital length of stay of −1.5 days (95% CI −2.8, −0.2), with similar operative time, clinically relevant postoperative pancreatic fistula (ISGPS grade B/C), and Clavien–Dindo grade ≥3 postoperative complications. Conclusion: Both SP-RADP and SP-LADP proved to be safe and effective procedures, with minimal perioperative mortality and low postoperative morbidity. The robotic approach proved to be superior to the laparoscopic approach in terms of spleen preservation rate, intraoperative blood loss, and hospital length of stay.
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Bashir MU, Kandilis A, Jackson NM, Parikh JA, Jacobs MJ. Distal pancreatectomy outcomes: Perspectives from a community-based teaching institution. Ann Hepatobiliary Pancreat Surg 2020; 24:156-161. [PMID: 32457260 PMCID: PMC7271100 DOI: 10.14701/ahbps.2020.24.2.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 12/14/2022] Open
Abstract
Backgrounds/Aims Distal pancreatic resections are intricate operations with potential for significant morbidity; there is controversy surrounding the appropriate setting regarding surgeon/hospital volume. We report our distal pancreatectomy experience from a community-based teaching hospital. Methods This study includes all patients who underwent laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP) for benign and malignant lesions between June 2004 and October 2017. Both groups were compared for perioperative characteristics, parenchymal resection technique, and outcomes. Results 138 patients underwent distal pancreatectomy during this time. The distribution of LDP and ODP was 68 and 70 respectively. Operative time (146 vs. 174 min), blood loss (139 vs. 395 ml) and mean length of stay (4.8 vs. 8.0 days) were significantly lower in the laparoscopic group. The 30-day Clavien Grade 2/3 morbidity rate was 13.7% (19/138) and the incidence of Grade B/C pancreatic fistula was 6.5% (9/138), with no difference between ODP and LDP. 30-day mortality was 0.7% (1/138). 61/138 resections had a malignancy on final pathology. ODP mean tumor diameter was greater (6.4 cm vs. 2.9 cm), but there was no significant difference in the mean number of harvested nodes (8.6 vs. 7.4). The cost of hospitalization, including readmissions and surgery was significantly lower for LDP ($7558 vs. $11610). Conclusions This series of distal pancreatectomies indicates a shorter hospital stay, less operative blood loss and reduced cost in the LDP group, and comparable morbidity and oncologic outcomes between LDP and ODP. It highlights the feasibility and safety of these complex surgeries in a community setting.
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Affiliation(s)
- Muhammad Umair Bashir
- Department of Surgery, Ascension Providence and Providence Park Hospitals, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Apostolos Kandilis
- Department of Surgery, Ascension Providence and Providence Park Hospitals, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Nancy M Jackson
- Department of Research, Ascension Providence and Providence Park Hospitals, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Janak A Parikh
- Department of Surgery, Ascension Providence and Providence Park Hospitals, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Michael J Jacobs
- Department of Surgery, Ascension Providence and Providence Park Hospitals, Michigan State University College of Human Medicine, Southfield, MI, USA
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Pais-Costa SR, Sousa GCCD, Araujo SLM, Lima OAT, Martins SJ, Torres OJ. LAPAROSCOPIC DISTAL PANCREATECTOMY WITH OR WITHOUT SPLEEN PRESERVATION: COMPARATIVE ANALYSIS OF SHORT AND LONG-TERM OUTCOMES. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2019; 32:e1461. [PMID: 31826088 PMCID: PMC6902889 DOI: 10.1590/0102-672020190001e1461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/21/2019] [Indexed: 11/26/2022]
Abstract
Background: Laparoscopic distal pancreatectomy (LDP) is the preferred approach for
resection of tumors in the distal pancreas because of its many advantages
over the open approach. Aim: To analyse and compare short and long-term outcomes from LDP performed
through two different techniques: with splenectomy vs. spleen preservation
and splenic vessel preservation. Method: Fifty-eight patients were operated and subsequently divided between two
groups: Group 1, LDP with splenectomy (LDPS); and Group 2, LDP with spleen
preservation and preservation of splenic vessels (LDPSPPSV). Results: The epidemiological characteristics were statistically similar between the
two groups (age, gender, BMI and lesion size). Both the mean of operative
time (p=0.04) and the mean of intra-operative blood loss (p=0,03) were
higher in Group 1. The mean of resected lymph nodes was also higher in Group
1 (p<0.000). There were no statistic differences between the groups in
relation to open conversion, morbidity or early postoperative mortality. The
mean hospital stay was similar between groups. Pancreatic fistula (grade B
and C) was similar between the groups. The mean of overall follow-up was
37.6 months (5-96). Late complications were similar between the groups. Conclusion: Both techniques were superimposable; however, LDPS presented, respectively,
higher intra-operative bleeding, longer duration of the operation and higher
number of lymph nodes resected. No differences were observed in the studied
period in relation to the appearance of infections or neoplasm related to
splenectomy during follow-up. Maintenance of the spleen avoided periodic
immunizations in patients in LDPSPSV. It is indicated in small pancreatic
lesions with indolent course.
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Affiliation(s)
- Sergio Renato Pais-Costa
- Santa Lúcia Hospital, Brasília, DF; Brazil.,Brasília Hospital, DF; Brazil.,Brasília University, DF; Brazil
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Nagasaki T, Mise Y, Honma S, Sato T, Akiyoshi T, Fukunaga Y, Tominaga T, Nagaoka T, Yamaguchi T, Ueno M. Simultaneous laparoscopic left hemicolectomy and spleen-preserving distal pancreatectomy for descending colon cancer with pancreatic invasion. Asian J Endosc Surg 2019; 12:334-336. [PMID: 30264485 DOI: 10.1111/ases.12655] [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: 08/09/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 11/28/2022]
Abstract
Here, we describe laparoscopic colectomy with spleen-preserving distal pancreatectomy for descending colon cancer with pancreatic tail invasion. A 69-year-old man with descending colon cancer staged as clinical state IIIC (cT4b [pancreas] N1M0) underwent definitive laparoscopic surgery that was performed in collaboration with surgeons who specialize in laparoscopic colorectal and hepatobiliary-pancreatic laparoscopy. After the left colon was mobilized, tumor infiltration of the pancreas, but not the splenic vessels, was confirmed, and the spleen was preserved. The procedures were safely completed laparoscopically, without intraoperative and postoperative complications. Laparoscopic multivisceral resection could be a treatment option for similar patients but only when performed by multidisciplinary specialists.
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Affiliation(s)
- Toshiya Nagasaki
- Gastroenterological Center, Department of Gastroenterological Surgery, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Yoshihiro Mise
- Gastroenterological Center, Department of Gastroenterological Surgery, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Satoru Honma
- Gastroenterological Center, Department of Gastroenterological Surgery, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Takafumi Sato
- Gastroenterological Center, Department of Gastroenterological Surgery, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Takashi Akiyoshi
- Gastroenterological Center, Department of Gastroenterological Surgery, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Yosuke Fukunaga
- Gastroenterological Center, Department of Gastroenterological Surgery, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Tetsuro Tominaga
- Gastroenterological Center, Department of Gastroenterological Surgery, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Tomoyuki Nagaoka
- Gastroenterological Center, Department of Gastroenterological Surgery, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Tomohiro Yamaguchi
- Gastroenterological Center, Department of Gastroenterological Surgery, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Masashi Ueno
- Gastroenterological Center, Department of Gastroenterological Surgery, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
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Warshaw Technique in Laparoscopic Spleen-Preserving Distal Pancreatectomy: Surgical Strategy and Late Outcomes of Splenic Preservation. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4074369. [PMID: 31317027 PMCID: PMC6601470 DOI: 10.1155/2019/4074369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/15/2019] [Accepted: 05/12/2019] [Indexed: 12/28/2022]
Abstract
Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) can be accomplished with either the preservation or the resection of splenic vessels; the latter is also known as Warshaw technique. Our study is designed to investigate the operation selection strategy when proceeding LSPDP and to evaluate the long-term outcomes of patients undergoing Warshaw surgery. The medical records and follow-up data of patients who underwent LSPDP in Qilu Hospital, Shandong University, were reviewed retrospectively. A total of thirty-five patients were involved in this study, including 17 cases of patients who were treated with Warshaw procedure (WT) while the other 18 cases had splenic vessels preserved (SVP). Compared with the SVP group, the operative time and intraoperative blood loss in WT group were improved significantly. The incidence of early postoperative splenic infarction was higher in WT group. However, there was no report of splenic abscess or second operation. Follow-up data confirmed that there was no significant difference in spleen phagocytosis and immune function compared with normal healthy population. Our study confirms that LSPDP-Warshaw procedure is a safe and efficient treatment for the benign or low grade malignant tumors in distal pancreas in selected patients. The long-term spleen function is normal after Warshaw procedure. Preoperative assessment and intraoperative exploration are recommended for the selection of operation approaches.
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Coelho JCU, da Costa MAR, Ramos EJB, Torres AR, Savio MC, Claus CMP. Surgical Management of Solid Pseudopapillary Tumor of the Pancreas. JSLS 2019; 22:JSLS.2018.00032. [PMID: 30740012 PMCID: PMC6365096 DOI: 10.4293/jsls.2018.00032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and Objectives: Although solid pseudopapillary tumor (SPT) of the pancreas is rare, its diagnosis has increased severalfold in the past decades. We present our experience in the management of SPT, including a patient who experienced tumor rupture during laparoscopy pancreatic resection. Methods: Data on all patients with SPT who were subjected to surgical treatment were retrospectively obtained. Results: Of 20 patients evaluated, 17 (85%) were females. The mean age was 31 years. Tumor size varied from 2.7 × 1.5 to 13.5 × 10.0 cm, with a mean of 6.4 × 7.6 cm. The most common location was the tail and/or body of the pancreas (14 patients [70%]). Pancreatic tumor resection was performed in 19 patients (50%). The type of resection depended on tumor location and size: distal pancreatectomy (n = 13), pancreatoduodenectomy (n = 5), and central pancreatectomy (n = 1) Pancreatic resection was performed via laparoscopy in 7 patients who underwent distal pancreatectomy. Tumor resection was not performed in only 1 patient (5%), due to invasion of mesenteric vessels and presence of liver metastases. One patient had tumor rupture during laparoscopic resection, with no apparent macroscopic dissemination of the tumor. All 19 patients who underwent SPT resection had no tumor recurrence, including a patient with capsule invasion and another patient with tumor rupture during surgical dissection. The mean follow-up time was 38 months (range, 6–72 months). Conclusion: Complete SPT resection is possible in most patients, with a low recurrence rate. Because of its large size, laparoscopic resection of SPT's should be performed only by experienced surgeons to avoid tumor rupture.
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Affiliation(s)
- Julio C U Coelho
- Division of Gastrointestinal Surgery of the Hospital Nossa Senhora das Graças and Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
| | - Marco A R da Costa
- Division of Gastrointestinal Surgery of the Hospital Nossa Senhora das Graças and Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
| | - Eduardo J B Ramos
- Division of Gastrointestinal Surgery of the Hospital Nossa Senhora das Graças and Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
| | - André Ritzmann Torres
- Division of Gastrointestinal Surgery of the Hospital Nossa Senhora das Graças and Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
| | - Mariane Christina Savio
- Division of Gastrointestinal Surgery of the Hospital Nossa Senhora das Graças and Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
| | - Christiano M P Claus
- Division of Gastrointestinal Surgery of the Hospital Nossa Senhora das Graças and Clinical Hospital of the Federal University of Parana, Curitiba, Brazil
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Laparoscopic Distal Pancreatectomy: Our Experience in a Tertiary Referral Center. Surg Laparosc Endosc Percutan Tech 2019; 29:285-289. [PMID: 30676539 DOI: 10.1097/sle.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite an increase in the number of laparoscopic distal pancreatectomy (LDP) procedures being performed, the long-term oncology and operative results are still unclear. The aim of this study was to present the surgical and long-term results of patients undergoing LDP for the treatment of distal pancreatic tumors. MATERIALS AND METHODS A retrospective review was made of patients who underwent LDP in our clinic, between 2006 and 2018, and who were diagnosed with pancreas tail, neck, and corpus tumors. For the purposes of this study, the data related to the preoperative, operative, and postoperative characteristics of the patients were determined. RESULTS A total of 46 patients were identified as suitable for inclusion in the study. Of these, 52.1% were female individuals, and the average age of the whole group was 63 years. Previous surgery for malignant diseases was recorded for 54.3% of the patients, due to premalignant diseases in 13% and benign diseases in 32.7%. On average, 10 lymph nodes were removed from patients diagnosed with malignant tumors. The conversion rate was found to be 2.1%. The postoperative pancreatic fistula rate was 26%, and there was 1 complication each of grades III and IV according to the Clavien-Dindo classification. The mortality rate was 0%. CONCLUSIONS It was concluded that LDP of distal pancreas tumors seems to be both safe and effective in respect of the long-term results in addition to the early results of the operation.
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13
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Ishikawa Y, Ban D, Watanabe S, Akahoshi K, Ono H, Mitsunori Y, Kudo A, Tanaka S, Tanabe M. Splenic artery as a simple landmark indicating difficulty during laparoscopic distal pancreatectomy. Asian J Endosc Surg 2019; 12:81-87. [PMID: 29656597 DOI: 10.1111/ases.12485] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 02/17/2018] [Accepted: 02/26/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The use of laparoscopic distal pancreatectomy (LDP) is increasing worldwide. It is important for surgeons to predict preoperatively the difficulty and risks of a surgery. However, very few reports have evaluated the impact of patient or tumor factors on the difficulty of LDP. We aimed to determine the predictors of technical difficulties when performing LDP. METHODS This study included 34 patients who underwent LDP. Patient information was obtained retrospectively and included age, gender, BMI, primary disease, previous abdominal surgery, previous pancreatitis, tumor size, tumor proximity to the splenic arterial origin, type of splenic artery (SpA), operative time, blood loss, postoperative pancreatic fistula, and length of hospital stay. Univariate and multivariate analyses were performed to determine the predictors of a long operative time. SpA anatomy was classified into two types based on the relationship between its origin and the pancreas. Patients whose SpA origin was upward of the pancreatic parenchyma were classified as SpA type 1, whereas patients whose SpA origin was covered by the pancreatic parenchyma were classified as SpA type 2. RESULTS Multivariate analysis revealed SpA type 2 to be an independent risk factor for a long operation (odds ratio = 9.925; 95% confidence interval: 1.461-67.412; P = 0.019). SpA type 2 was related to a longer operative time (P < 0.001) and greater intraoperative blood loss (P = 0.001). CONCLUSION Classification according to SpA type is simple and useful for predicting technical difficulty when performing LDP.
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Affiliation(s)
- Yoshiya Ishikawa
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Ban
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuichi Watanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Akahoshi
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroaki Ono
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Mitsunori
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Kudo
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinji Tanaka
- Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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14
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Malya FÜ, Bektaşoğlu HK, Hasbahçeci M, Taşçı Y, Kunduz E, Karatepe O, Dolay K. Laparoscopic surgery in distal pancreatic tumors. Turk J Surg 2017; 33:288-291. [PMID: 29260135 DOI: 10.5152/turkjsurg.2017.3675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 03/03/2017] [Indexed: 11/22/2022]
Abstract
Objective Laparoscopic distal pancreatectomy is increasingly being used in the surgical treatment of corpus and distal pancreatic tumors. In this study, patients who underwent laparoscopic or open distal pancreatectomy for benign or malignant causes were evaluated in terms of tumor characteristics and perioperative outcomes. Material and Methods We retrospectively reviewed data from a total of 27 distal pancreatectomy cases performed for benign or malignant causes in the General Surgery Department between January 2013 and December 2015. Groups were compared according to the demographic characteristics of patients, operation type (laparoscopic or open, with splenectomy or spleen preservation), operation time, surgical site infection (superficial, deep wound infection, or intra-abdominal abscess), pancreatic fistula development, and histopathological examination results. Results Both groups were similar in terms of age, sex, and body mass index (p=0.42). Tumor diameter was similar (p=0.18). The total number of resected lymph nodes was similar in both groups (p=0.6). Pancreatic fistula developed in one patient in each group. Mean hospital stay duration and the amount of intraoperative bleeding were similar in both groups. The laparoscopy group had a markedly lower overall morbidity rate (p=0.08). There was no mortality observed in the study subjects. Conclusion Laparoscopic distal pancreatectomy can be safely performed as a minimally invasive procedure in experienced centers and in selected cases without increasing perioperative complication rates, particularly in benign cases. Although oncological outcomes are acceptable for malignant cases, future prospective controlled studies are necessary for more reliable evaluation.
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Affiliation(s)
- Fatma Ümit Malya
- Department of General Surgery, Bezmialem Vakif University School of Medicine, İstanbul, Turkey
| | | | - Mustafa Hasbahçeci
- Department of General Surgery, Bezmialem Vakif University School of Medicine, İstanbul, Turkey
| | - Yunus Taşçı
- Department of General Surgery, Bezmialem Vakif University School of Medicine, İstanbul, Turkey
| | - Enver Kunduz
- Department of General Surgery, Bezmialem Vakif University School of Medicine, İstanbul, Turkey
| | - Oğuzhan Karatepe
- Department of General Surgery, Memorial Şişli Hospital, İstanbul, Turkey
| | - Kemal Dolay
- Department of General Surgery, Bezmialem Vakif University School of Medicine, İstanbul, Turkey
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Laparoscopic distal resection of the pancreas. Can be all resections of body and tail of the pancreas called the same? Contemp Oncol (Pozn) 2017; 21:174-177. [PMID: 28947889 PMCID: PMC5611508 DOI: 10.5114/wo.2017.68627] [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: 11/03/2016] [Accepted: 02/15/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction Distal resection of the pancreas is a routine procedure in high-volume centres. However, the volume of this procedure can vary. This variation plays a very important role in laparoscopic approach of pancreatic surgery and can be a real challenge if the anatomical situation is underestimated. Aim of the study To present our experience in minimally invasive treatment of the pancreatic tumours and to discuss different approaches to different anatomical situations. Material and methods We performed a retrospective analysis of patients, who underwent laparoscopic pancreas resection for pancreatic cancer in our hospital since 2014 to 2016 February. According to extension of operation, patients were divided into two groups: distal pancreatectomy and left hemipancreatectomy for cases that required preparation of the portal vein. Demographic characteristics, and operative and postoperative data were compared between both groups. Results Out of 16 patients, distal pancreatectomy was performed for 7 (43.8%) and left hemipancreatectomy for 9 (56.2%) patients. For 1 (14.3%) laparoscopic distal pancreatectomy and for 2 (22.2%) laparoscopic left hemipancreatectomy patients surgical conversion to laparotomy was performed. The average operation time was 205 (195–245) min for distal pancreatectomy and 412.5 (280–520) min for left hemipancreatectomy group (p = 0.001), blood loss 125 (20–250) ml and 250 (50–1800) ml accordingly (p = 0.138). Totally postoperative fistula occurred in 7 (43.8%) cases; out of them, 5 (71.4%) patients were from the left hemipancreatectomy group. Conclusions Laparoscopic left hemipancreatectomy is more complicated than distal pancreatectomy. Extension and technique selection of distal resection of the pancreas depends on the Yonsei criteria and tumour relation to the portal vein.
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16
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Tada S, Iida T, Anazawa T, Yagi S, Seo S, Masui T, Kaido T, Takaori K, Uemoto S. Successful laparoscopic distal pancreatectomy for a large solid pseudopapillary neoplasm: A case report. Asian J Endosc Surg 2017; 10:317-320. [PMID: 28176498 DOI: 10.1111/ases.12360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/22/2016] [Accepted: 12/27/2016] [Indexed: 01/15/2023]
Abstract
A 30-year-old Japanese woman presented at our hospital with a pancreatic tumor. Contrast-enhanced CT revealed a tumor with a 12-cm diameter in the pancreatic body and tail. In the preoperative setting, endoscopic ultrasound-guided fine-needle aspiration permitted a histopathological diagnosis of solid pseudopapillary neoplasm. Twhe patient underwent laparoscopic distal pancreatectomy with splenectomy. Our procedure involved three steps. Firstly, the splenic artery was occluded to block inflow of blood to the tumor. Then, we transected the neck of the pancreas using radical antegrade modular pancreatosplenectomy. Finally, hand-assisted laparoscopic surgery allowed us to secure the operating field and easily handle the large tumor. This enabled us to accomplish laparoscopic distal pancreatectomy, and en-bloc resection was completed. The patient was discharged without major complications. Laparoscopic distal pancreatectomy for huge solid pancreatic tumors can be completed safely.
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Affiliation(s)
- Seiichiro Tada
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Taku Iida
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Anazawa
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shintaro Yagi
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoru Seo
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshihiko Masui
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshimi Kaido
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kyoichi Takaori
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Laparoscopic Left Pancreatectomy in the United Kingdom: Analysis of a Six-Year Experience in a Single Tertiary Center. Pancreas 2016; 45:1204-7. [PMID: 26784910 DOI: 10.1097/mpa.0000000000000605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Laparoscopic techniques have been slow to establish a role in pancreatic surgery. Worldwide, laparoscopic left pancreatectomy (LLP) is gaining in popularity; however, there remains little published data from the United Kingdom.We aimed to evaluate the results of LLP performed in a single UK pancreatic unit. METHODS Patients undergoing LLP for lesions in the body and tail of the pancreas between April 2009 and April 2015 were identified. Patient records were reviewed retrospectively. RESULTS Laparoscopic left pancreatectomy was performed on 46 patients, median age, 62 years (range, 19-84). The spleen was preserved in 27 patients (93% of planned), and 6 (13%) operations were converted to open. The overall morbidity rate was 39%; 28 patients had no complications. Significant complications were seen in 7 (15%) patients; this included 3 pancreatic fistula (6.5%) and 1 mortality (2%). Median length of stay was 6 days (range, 3-28). Histology revealed 15 neuroendocrine tumors, 8 adenocarcinomas, 4 mucinous cystadenomas, 1 intraductal papillary mucinous neoplasm, 2 metastases, and 16 other benign pathologies. CONCLUSIONS Laparoscopic pancreatic surgery has a low risk of significant complications. Our results offer encouragement to identify LLP as the gold standard approach for premalignant lesions. Further work should clarify the outcomes for malignant lesions.
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18
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Han HS, Yoon YS, Kwon SU, Cho JY, Choi Y, Jang JS. Laparoscopic spleen preserving distal pancreatectomy. J Vis Surg 2016; 2:146. [PMID: 29078533 PMCID: PMC5638268 DOI: 10.21037/jovs.2016.08.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/11/2016] [Indexed: 01/21/2023]
Abstract
Minimal invasive surgery is growing rapidly in vast fields of abdominal surgery. Nowadays, due to the development of laparoscopic instruments and improvement of surgical technique, laparoscopic pancreas surgery is becoming more widely adopted. Laparoscopic distal pancreatectomy has now become a standard procedure for the benign or borderline malignant tumor located in body or tail of pancreas, but laparoscopic spleen and splenic vessel preserving distal pancreatectomy is still a technically demanded operation. In this multimedia article, we will demonstrate our technique of laparoscopic spleen and splenic vessel preserving distal pancreatectomy.
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Affiliation(s)
- Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Sungnam, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Sungnam, Korea
| | - Seong Uk Kwon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Sungnam, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Sungnam, Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Sungnam, Korea
| | - Jae Seong Jang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Sungnam, Korea
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Fernandes E, Giulianotti PC. Robotic-assisted pancreatic surgery. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 20:583-9. [PMID: 23588851 DOI: 10.1007/s00534-013-0615-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Pancreatic surgery is a challenging application of minimally invasive surgery. Due to the complexity of the surgical technique, requiring dissection along major abdominal vessels as well as delicate reconstruction involving biliary, pancreatic and enteric anastomoses, reports on laparoscopic pancreatic surgery have been scanty. With the advent of robotic-assisted surgery, however, the increased dexterity granted by endo-wristed instruments, the improved three-dimensional vision and the computer filtration of the surgeon's movements have brought minimally invasive pancreatic surgery into a new era. METHODS As the surgical group which has performed the highest number of robotic-assisted pancreatic procedures worldwide, we review the state of the art of minimally invasive robotic-assisted pancreatic surgery. Clinical results from all major robotic-assisted pancreatic surgery series are considered. RESULTS Preliminary reports from the published major pancreatic surgery series show encouraging results, with morbidity and mortality comparable to open surgery. Preliminary data on cancer survival rates also appear to be similar to open series. CONCLUSION Robotic-assisted pancreatic surgery is safe and feasible for all pancreatic diseases. The complexity of pancreatic procedures warrant them to be carried out in specialised centres, where short- and long-term outcomes seem to be similar to the ones achieved in open surgery.
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Affiliation(s)
- E Fernandes
- Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, 840 South Wood Street, Chicago, IL, 60612, USA.
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20
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Goh BK, Wong JS, Chan CY, Cheow PC, Ooi LL, Chung AY. First experience with robotic spleen-saving, vessel-preserving distal pancreatectomy in Singapore: a report of three consecutive cases. Singapore Med J 2016; 57:464-9. [PMID: 26805665 DOI: 10.11622/smedj.2016020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The use of laparoscopic distal pancreatectomy (LDP) has increased worldwide due to the reported advantages associated with this minimally invasive procedure. However, widespread adoption is hindered by its technical complexity. Robotic distal pancreatectomy (RDP) was introduced to overcome this limitation, but worldwide experience with RDP is still lacking. There is presently evidence that RDP is associated with decreased conversion rate and increased splenic preservation as compared to LDP. METHODS We conducted a prospective study on our initial experience with robotic spleen-saving, vessel-preserving distal pancreatectomy (SSVP-DP) between July 2013 and April 2014. RESULTS Three consecutive patients underwent attempted robotic SSVP-DP. The indications were a 2.1-cm indeterminate cystic neoplasm, 4.5-cm solid pseudopapillary neoplasm and 1.2-cm pancreatic neuroendocrine tumour. For all three patients, the procedure was completed without conversion, and the spleen, with its main vessels, was successfully conserved. The median total operation time, blood loss and postoperative stay were 350 (range 300-540) minutes, 200 (range 50-300) mL and 7 (range 6-14) days, respectively. Two patients had minor Clavien-Dindo Grade I complications (one Grade A pancreatic fistula and one postoperative ileus). One patient had a Clavien-Dindo Grade IIIa complication (Grade B pancreatic fistula requiring percutaneous drainage). All patients were well at the time of reporting after at least six months of follow-up. CONCLUSION Our preliminary experience with robotic SSVP-DP confirmed the feasibility of the procedure.
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Affiliation(s)
- Brian Kp Goh
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Jen-San Wong
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - Chung-Yip Chan
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore
| | - Peng-Chung Cheow
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - London Lpj Ooi
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore.,Division of Surgery, Singapore General Hospital, Singapore
| | - Alexander Yf Chung
- Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore
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Fujii M, Yoshioka M, Shiode J. Two Cases of an Epidermoid Cyst Developing in an Intrapancreatic Accessory Spleen Identified during Laparoscopic Distal Pancreatectomy. Intern Med 2016; 55:3137-3141. [PMID: 27803407 PMCID: PMC5140862 DOI: 10.2169/internalmedicine.55.7141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Epidermoid cysts presenting within an intrapancreatic accessory spleen are rare non-neoplastic cysts typically occurring in the pancreatic tail. This entity is difficult to diagnose given there are many types of pancreatic neoplastic cysts. We herein describe two cases of an epidermoid cyst within an intrapancreatic accessory spleen for which we performed a resection by laparoscopic distal pancreatectomy. Epidermoid cysts in an intrapancreatic accessory spleen should therefore be considered in the differential diagnosis of pancreatic tail cystic lesions. Laparoscopic distal pancreatectomy can be a useful, minimally invasive surgical approach for treating these cysts as well as for the treatment of benign or low-grade malignant tumors located in the pancreatic body or tail.
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Affiliation(s)
- Masakuni Fujii
- Department of Internal medicine, Okayama Saiseikai General Hospital, Japan
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Bencini L, Annecchiarico M, Farsi M, Bartolini I, Mirasolo V, Guerra F, Coratti A. Minimally invasive surgical approach to pancreatic malignancies. World J Gastrointest Oncol 2015; 7:411-421. [PMID: 26690680 PMCID: PMC4678388 DOI: 10.4251/wjgo.v7.i12.411] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/08/2015] [Accepted: 10/27/2015] [Indexed: 02/05/2023] Open
Abstract
Pancreatic surgery for malignancy is recognized as challenging for the surgeons and risky for the patients due to consistent perioperative morbidity and mortality. Furthermore, the oncological long-term results are largely disappointing, even for those patients who experience an uneventfully hospital stay. Nevertheless, surgery still remains the cornerstone of a multidisciplinary treatment for pancreatic cancer. In order to maximize the benefits of surgery, the advent of both laparoscopy and robotics has led many surgeons to treat pancreatic cancers with these new methodologies. The reduction of postoperative complications, length of hospital stay and pain, together with a shorter interval between surgery and the beginning of adjuvant chemotherapy, represent the potential advantages over conventional surgery. Lastly, a better cosmetic result, although not crucial in any cancerous patient, could also play a role by improving overall well-being and patient self-perception. The laparoscopic approach to pancreatic surgery is, however, difficult in inexperienced hands and requires a dedicated training in both advanced laparoscopy and pancreatic surgery. The recent large diffusion of the da Vinci® robotic platform seems to facilitate many of the technical maneuvers, such as anastomotic biliary and pancreatic reconstructions, accurate lymphadenectomy, and vascular sutures. The two main pancreatic operations, distal pancreatectomy and pancreaticoduodenectomy, are approachable by a minimally invasive path, but more limited interventions such as enucleation are also feasible. Nevertheless, a word of caution should be taken into account when considering the increasing costs of these newest technologies because the main concerns regarding these are the maintenance of all oncological standards and the lack of long-term follow-up. The purpose of this review is to examine the evidence for the use of minimally invasive surgery in pancreatic cancer (and less aggressive tumors), with particular attention to the oncological results and widespread reproducibility of each technique.
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23
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Antonakis PT, Ashrafian H, Martinez-Isla A. Pancreatic insulinomas: Laparoscopic management. World J Gastrointest Endosc 2015; 7:1197-1207. [PMID: 26566426 PMCID: PMC4639741 DOI: 10.4253/wjge.v7.i16.1197] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/22/2015] [Accepted: 09/07/2015] [Indexed: 02/05/2023] Open
Abstract
Insulinomas are rare pancreatic neuroendocrine tumors that are most commonly benign, solitary, and intrapancreatic. Uncontrolled insulin overproduction from the tumor produces neurological and adrenergic symptoms of hypoglycemia. Biochemical diagnosis is confirmed by the presence of Whipple’s triad, along with corroborating measurements of blood glucose, insulin, proinsulin, C-peptide, β-hydroxybutyrate, and negative tests for hypoglycemic agents during a supervised fasting period. This is accompanied by accurate preoperative localization using both invasive and non-invasive imaging modalities. Following this, careful preoperative planning is required, with the ensuing procedure being preferably carried out laparoscopically. An integral part of the laparoscopic approach is the application of laparoscopic intraoperative ultrasound, which is indispensable for accurate intraoperative localization of the lesion in the pancreatic region. The extent of laparoscopic resection is dependent on preoperative and intraoperative findings, but most commonly involves tumor enucleation or distal pancreatectomy. When performed in an experienced surgical unit, laparoscopic resection is associated with minimal mortality and excellent long-term cure rates. Furthermore, this approach confers equivalent safety and efficacy rates to open resection, while improving cosmesis and reducing hospital stay. As such, laparoscopic resection should be considered in all cases of benign insulinoma where adequate surgical expertise is available.
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Yamaguchi M, Fukuda T, Nakahara M, Amano M, Takei D, Kawashima M, Sumi Y, Amano H, Yonehara S, Hanada K, Noriyuki T. Multicentric solid pseudopapillary neoplasms of the pancreas diagnosed by endoscopic ultrasound-guided fine needle aspiration: a case report. Surg Case Rep 2015; 1:110. [PMID: 26943434 PMCID: PMC4623871 DOI: 10.1186/s40792-015-0111-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 10/16/2015] [Indexed: 02/06/2023] Open
Abstract
Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor. This neoplasm usually arises as a single mass; multicentricity is exceptionally rare. We report the preoperative diagnosis of multicentric SPNs by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). A 32-year-old woman presented to the hospital with a pancreatic tumor that was detected on abdominal echography. Contrast-enhanced computed tomography (CT) scans revealed a 5-mm low-density mass in the body of the pancreas and a 10-mm mass in the tail of the pancreas. Magnetic resonance imaging (MRI) also revealed two tumors in the body and tail of the pancreas. On endoscopic ultrasonography (EUS), two indistinct and heterogeneous echogenic masses were found, and EUS-FNA was performed for each of these tumors. Cytological analysis revealed that the two masses were highly cellular with papillary groups of small, uniform, oval cells surrounding a fibrovascular core. Immunohistochemistry was positive for α-1 antitrypsin, vimentin, neuron-specific enolase (NSE), CD10, and progesterone receptor. These features confirmed the preoperative diagnosis of multicentric SPNs. The patient underwent laparoscopic distal pancreatectomy with splenectomy. The final pathologic diagnosis was multicentric SPNs. During 2 years of follow-up, she has not developed any recurrence.
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Affiliation(s)
- Megumi Yamaguchi
- Department of Surgery, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, Japan.
| | - Toshikatsu Fukuda
- Department of Surgery, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, Japan.
| | - Masahiro Nakahara
- Department of Surgery, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, Japan.
| | - Mio Amano
- Department of Gastroenterology, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, Japan.
| | - Daisuke Takei
- Department of Surgery, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, Japan.
| | - Masumi Kawashima
- Department of Surgery, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, Japan.
| | - Yusuke Sumi
- Department of Surgery, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, Japan.
| | - Hironobu Amano
- Department of Surgery, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, Japan.
| | - Shuji Yonehara
- Department of Diagnostic Pathology, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, Japan.
| | - Keiji Hanada
- Department of Gastroenterology, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, Hiroshima, 722-8508, Japan.
| | - Toshio Noriyuki
- Faculty of Medicine, Hiroshima University, 1-2-3, Kasumi, Hiroshima, 734-8551, Japan.
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Laparoscopic Distal Pancreatectomy with or without Preservation of the Spleen for Solid Pseudopapillary Neoplasm. Case Rep Surg 2015; 2015:487639. [PMID: 26587305 PMCID: PMC4637475 DOI: 10.1155/2015/487639] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
Solid pseudopapillary neoplasm (SPN) is a rare tumor of the pancreas. Laparoscopic distal pancreatectomy (DP) is a feasible and safe procedure, and successful spleen preservation rates are higher using a laparoscopic approach. We hypothesized that certain patients with SPN would be good candidates for laparoscopic surgery; however, few surgeons have reported laparoscopic DP for SPN. We discuss the preoperative assessment and surgical simulation for two SPN cases. A simulation was designed because we consider that a thorough preoperative understanding of the procedure based on three-dimensional image analysis is important for successful laparoscopic DP. We also discuss the details of the actual laparoscopic DP with or without splenic preservation that we performed for our two SPN cases. It is critical to use appropriate instruments at appropriate points in the procedure; surgical instruments are numerous and varied, and surgeons should maximize the use of each instrument. Finally, we discuss the key techniques and surgical pitfalls in laparoscopic DP with or without splenic preservation. We conclude that experience alone is inadequate for successful laparoscopic surgery.
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Ariyarathenam AV, Bunting D, Aroori S. Laparoscopic Distal Pancreatectomy Using the Modified Prolonged Prefiring Compression Technique Reduces Pancreatic Fistula. J Laparoendosc Adv Surg Tech A 2015; 25:821-5. [DOI: 10.1089/lap.2015.0200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Arun V. Ariyarathenam
- Peninsula HPB Unit, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - David Bunting
- Peninsula HPB Unit, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - Somaiah Aroori
- Peninsula HPB Unit, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
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Ntourakis D, Marescaux J, Pessaux P. Robotic spleen preserving distal pancreatectomy: how I do it (with video). World J Surg 2015; 39:292-6. [PMID: 25201472 DOI: 10.1007/s00268-014-2784-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Laparoscopic hepatobiliary surgery, although technically demanding, gains popularity due to the patient benefits of a mini-invasive approach. Laparoscopic distal pancreatectomy is a technically feasible and reproducible operation that doesn't require complex digestive reconstruction. It requires advanced laparoscopic skill for vascular dissection and control. Due to the absence of trials proving its oncological results it is mainly indicated for benign or borderline tumours of the pancreatic body and tail. Since for these tumours there is no indication for a lymph node dissection, there are benefits for the patient if the spleen is preserved. There is some evidence that robotic assistance facilitates the procedure and makes it accessible to surgeons diminishing the necessity of advanced laparoscopic skills. In this technical multimedia article, we present our method for a robotic mini-invasive spleen preserving distal pancreatectomy with preservation of the splenic vessels. The technique is presented in a stepwise approach with an accompanying video. We believe that the use of the Da Vinci robotic platform facilitates this demanding procedure.
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Affiliation(s)
- Dimitrios Ntourakis
- Digestive and Endocrine Surgery, Nouvel Hopital Civil, University of Strasbourg, 67000, Strabourg, France,
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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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29
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Laparoscopic spleen-preserving distal pancreatectomy for IPMN (with video). J Visc Surg 2015; 152:265-7. [PMID: 25797904 DOI: 10.1016/j.jviscsurg.2015.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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30
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Chong CCN, Lee KF, Fong AKW, Cheung SYS, Wong J, Lai PBS. Robot-assisted laparoscopic spleen-preserving distal pancreatectomy. SURGICAL PRACTICE 2015. [DOI: 10.1111/1744-1633.12103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | - Kit-Fai Lee
- Department of Surgery; Prince of Wales Hospital; Hong Kong
| | | | | | - John Wong
- Department of Surgery; Prince of Wales Hospital; Hong Kong
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Abstract
Pancreatic adenocarcinoma is one of the most aggressive cancers, and the decline in mortality observed in most other cancer diseases, has so far not taken place in pancreatic cancer. Complete tumor resection is a requirement for potential cure, and the reorganization of care in the direction of high patient-volume centers, offering multimodal treatment, has improved survival and Quality of Life. Also the rates and severity grade of complications are improving in high-volume pancreatic centers. One of the major problems worldwide is underutilization of surgery in resectable pancreatic cancer. Suboptimal investigation, follow up and oncological treatment outside specialized centers are additional key problems. New chemotherapeutic regimens like FOLFIRINOX have improved survival in patients with metastatic disease, and different adjuvant treatment options result in well documented survival benefit. Neoadjuvant treatment is highly relevant, but needs further evaluation. Also adjuvant immunotherapy, in the form of vaccination with synthetic K-Ras-peptides, has been shown to produce long term immunological memory in cytotoxic T-cells in long term survivors. Improvement in clinical outcome is already achievable and further progress is expected in the near future for patients treated with curative as well as palliative intention.
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Laparoscopic spleen-preserving distal pancreatectomy for insulinoma: experience of a single center. Int J Surg 2014; 12 Suppl 1:S152-5. [PMID: 24862672 DOI: 10.1016/j.ijsu.2014.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Laparoscopic spleen-preserving distal pancreatectomy is gaining acceptance for the treatment of insulinomas of the pancreatic body and tail. The aim of this report is to evaluate the feasibility, safety and outcomes of this procedure in a retrospective series. METHODS From May 2004 to November 2013, 9 patients underwent laparoscopic spleen-preserving distal pancreatectomy for benign insulinomas in our department. Tumors were single and sporadic in eight patients, while the remaining patient had insulinomas in the setting of multiple endocrine neoplasia type 1. Tumors were located by preoperative imaging in all cases. Laparoscopic ultrasound was always performed to guide the surgical procedure. RESULTS All the operations were carried out laparoscopically with a mean operative time of 110 min (range 90-210 min) and a mean blood loss of 50 ml (range 30-120 ml). One patient (11.1%) died on the 22nd post-operative day for massive intra-abdominal bleeding associated with pancreatitis of the stump. Two patients (22.2%) developed pancreatic fistula that healed conservatively. Mean postoperative hospital stay was 7.1 days (range 5-18 days). All alive patients were free from recurrence after a mean follow-up of 45 months (range 11-72 months). CONCLUSION Laparoscopic spleen-preserving distal pancreatectomy is safe and feasible for the management of benign insulinomas. Definition of the tumor with preoperative imaging and laparoscopic ultrasound is essential to achieve high cure rate with minimal conversion.
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Bencini L, Bernini M, Farsi M. Laparoscopic approach to gastrointestinal malignancies: Toward the future with caution. World J Gastroenterol 2014; 20:1777-1789. [PMID: 24587655 PMCID: PMC3930976 DOI: 10.3748/wjg.v20.i7.1777] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 11/07/2013] [Accepted: 11/30/2013] [Indexed: 02/06/2023] Open
Abstract
After the rapid acceptance of laparoscopy to manage multiple benign diseases arising from gastrointestinal districts, some surgeons started to treat malignancies by the same way. However, if the limits of laparoscopy for benign diseases are mainly represented by technical issues, oncologic outcomes remain the foundation of any procedures to cure malignancies. Cancerous patients represent an important group with peculiar aspects including reduced survival expectancy, worsened quality of life due to surgery itself and adjuvant therapies, and challenging psychological impact. All these issues could, potentially, receive a better management with a laparoscopic surgical approach. In order to confirm such aspects, similarly to testing the newest weapons (surgical or pharmacologic) against cancer, long-term follow-up is always recommendable to assess the real benefits in terms of overall survival, cancer-free survival and quality of life. Furthermore, it seems of crucial importance that surgeons will be correctly trained in specific oncologic principles of surgical oncology as well as in modern miniinvasive technologies. Therefore, laparoscopic treatment of gastrointestinal malignancies requires more caution and deep analysis of published evidences, as compared to those achieved for inflammatory bowel diseases, gastroesophageal reflux disease or diverticular disease. This review tries to examine the evidence available to date for the use of laparoscopy and robotics in malignancies arising from the gastrointestinal district.
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Abe N, Mori T, Sugiyama M. Tips on laparoscopic distal pancreatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 21:E41-7. [DOI: 10.1002/jhbp.95] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Nobutsugu Abe
- Department of Surgery; Kyorin University School of Medicine; 6-20-2 Shinkawa, Mitaka Tokyo 181-8611 Japan
| | - Toshiyuki Mori
- Department of Surgery; Kyorin University School of Medicine; 6-20-2 Shinkawa, Mitaka Tokyo 181-8611 Japan
| | - Masanori Sugiyama
- Department of Surgery; Kyorin University School of Medicine; 6-20-2 Shinkawa, Mitaka Tokyo 181-8611 Japan
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35
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Subar D, Gobardhan PD, Gayet B. Laparoscopic pancreatic surgery: An overview of the literature and experiences of a single center. Best Pract Res Clin Gastroenterol 2014; 28:123-32. [PMID: 24485260 DOI: 10.1016/j.bpg.2013.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 10/10/2013] [Accepted: 11/23/2013] [Indexed: 01/31/2023]
Abstract
Pancreatic surgery was reported as early as 1898. Since then significant developments have been made in the field of pancreatic resections. In addition, advances in laparoscopic surgery in general have seen the description of this approach in pancreatic surgery with increasing frequency. Although there are no randomized controlled trials, several large series and comparative studies have reported on the short and long term outcome of laparoscopic pancreatic surgery. Furthermore, in the last decade published systematic reviews and meta-analyses have reported on cost effectiveness and outcomes of these procedures.
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Affiliation(s)
- D Subar
- Department of General and HPB Surgery, Royal Blackburn Hospital, Lancashire, UK.
| | - P D Gobardhan
- Department of Surgery, Amphia Hospital, Breda, The Netherlands.
| | - B Gayet
- Department of Digestive Diseases, Institut Mutualiste Montsouris, Paris, France.
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36
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Lee CL, Di Y, Jiang YJ, Jin C, Fu DL. Epidermoid cyst of intrapancreatic accessory spleen: A case report and literature review. World J Surg Proced 2013; 3:54-59. [DOI: 10.5412/wjsp.v3.i3.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/14/2013] [Accepted: 09/04/2013] [Indexed: 02/06/2023] Open
Abstract
Epidermoid cyst of intrapancreatic accessory spleen is exceedingly rare; only 30 new cases have been reported in the English literature over the last 30 years. An accurate preoperative diagnosis was made in almost none of them because of the lack of reliable preoperative diagnostic methods. In this report, we present a case diagnosed with fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET). A 41-year-old female who had breast cancer was routinely followed up by measuring the concentration of tumor makers. An increasing level of serum carbohydrate antigen 19-9 was detected and a cystic lesion located at the tail of pancreas was found by ultrasonography. A whole body fluorine-18 FDG positron emission tomography was performed because of a high suspicion for either a malignancy of the pancreas or a recurrence of breast cancer. No increased uptake of FDG was noted and therefore the cystic lesion was considered as pancreatic benign disease. Because pancreatic malignancy could not be entirely ruled out, distal pancreatectomy and splenectomy were performed. The final pathological diagnosis was epidermoid cyst of intrapancreatic accessory spleen (ECIAS). The FDG-PET findings matched the histopathology. A literature review reveals that the common clinical manifestations of ECIAS include asymptomatic findings on clinical examination, an occasional increase in tumor makers on laboratory results and occurrence only in the pancreatic tail. It is often misdiagnosed due to its extreme rarity and lack of a specific radiographic sign. There is no evidence of malignancy in ECIAS. Open or laparoscopic spleen preserving distal pancreatectomy is the minimally invasive procedure that would provide the best surgical management for epidermoid cyst of intrapancreatic accessory spleen.
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Short-term perioperative outcomes after robot-assisted and laparoscopic distal pancreatectomy. J Robot Surg 2013; 8:125-32. [DOI: 10.1007/s11701-013-0438-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 11/13/2013] [Indexed: 01/27/2023]
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38
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Abu Hilal M, Takhar AS. Laparoscopic left pancreatectomy: current concepts. Pancreatology 2013; 13:443-8. [PMID: 23890145 DOI: 10.1016/j.pan.2013.04.196] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 04/17/2013] [Accepted: 04/17/2013] [Indexed: 12/11/2022]
Abstract
The minimally invasive approach has been slow to gain acceptance in the field of pancreatic surgery even though its advantages over the open approach have been extensively documented in the medical literature. The reasons for the reluctant use of the technique are manifold. Laparoscopic distal or left sided pancreatic resections have slowly become the standard approach to lesions of the pancreatic body and tail as a result of evolution in technology and experience. A number of studies have shown the potential advantages of the technique in terms of safety, blood loss, oncological and economic feasibility, hospital stay and time to recovery from surgery. This review aims to provide an overview of the recent advances in the field of laparoscopic left pancreatectomy (LLP) and discuss potential future developments.
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Affiliation(s)
- Mohammad Abu Hilal
- University Surgical Unit, Southampton General Hospital, Southampton, United Kingdom.
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