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Bejarano N, Busquets J, Peláez N, Secanella L, Sorribas M, Ramos E, Fabregat J. Experience in the resection of the uncinate process of the pancreas: Indications and results. Literature review. Cir Esp 2023; 101:522-529. [PMID: 36283601 DOI: 10.1016/j.cireng.2022.10.011] [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: 01/25/2022] [Revised: 07/25/2022] [Accepted: 08/21/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The aim of our study is to assess the accumulated experience in the use of uncinatectomy (UC) as a parenchymal-sparing pancreatectomy technique. METHOD We have carried out a observational and descriptive study including restrospectively all the patients undergoing UC at Hospital Universitary de Bellvitge (HUB) and an exhaustive review of the cases described in the english literature. RESULTS From 2003 to 2019, seven patients have been operated by UC in the HUB with a diagnostic orientation of pancreatic lesion considered premalignant. All patients have presented morbidity, mainly in the form of postoperative pancreatic fistula, and none of them have presented endocrine or exocrine pancreatic insufficiency. Currently, all patients are alive and without recurrence of neoplastic disease. Another 29 cases have been described in the literature. Of all the cases (36 patients), the approach was minimally invasive (laparoscopic or robotic) in 6 patients (16.7%), leading to a shorter hospital stay. The global incidence of pancreatic fistula is 50%, with a re-admission rate of less than 10%, but without requiring re-intervention. CONCLUSIONS UC is an infrequent and poorly standardized technique for the resection of benign lesions or those with low potential for malignancy located in the uncinate process of the pancreas. Although it is associated with equal or greater morbidity than standardized resection techniques, it offers excellent preservation of endocrine and exocrine pancreatic function, with the consequent long-term benefit in the patients life quality.
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Affiliation(s)
- Natalia Bejarano
- Hepato-Bilio-Pancreatic Surgery Unit, General and Digestive Surgery Service, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona (UAB), Sabadell, Barcelona, Spain.
| | - Juli Busquets
- Hepato-Bilio-Pancreatic Surgery and Liver Transplantation Unit, General and Digestive Surgery Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain; Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Sapin
| | - Núria Peláez
- Hepato-Bilio-Pancreatic Surgery and Liver Transplantation Unit, General and Digestive Surgery Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Sapin
| | - Lluís Secanella
- Hepato-Bilio-Pancreatic Surgery and Liver Transplantation Unit, General and Digestive Surgery Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Sapin; Department of Fundamental and Medicosurgical Nursing, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Maria Sorribas
- Hepato-Bilio-Pancreatic Surgery and Liver Transplantation Unit, General and Digestive Surgery Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Emilio Ramos
- Hepato-Bilio-Pancreatic Surgery and Liver Transplantation Unit, General and Digestive Surgery Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain; Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Sapin
| | - Juan Fabregat
- Hepato-Bilio-Pancreatic Surgery and Liver Transplantation Unit, General and Digestive Surgery Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain; Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Sapin
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Experiencia en la resección del proceso uncinado del páncreas: indicaciones y resultados. Revisión de la literatura. Cir Esp 2023. [DOI: 10.1016/j.ciresp.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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3
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Cruciani B, Touzet C, Robin E, Bismuth C. Left pancreaticoduodenostomy after removal of the right lobe and the head of the pancreas in a cat. Vet Surg 2022; 51:1304-1310. [PMID: 36099343 DOI: 10.1111/vsu.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/21/2022] [Accepted: 08/07/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report a surgical technique for pancreaticoduodenostomy and its outcomes in a cat. ANIMALS A 14-year-old domestic cat. STUDY DESIGN Case report. METHODS A cat was referred to our hospital with a large abdominal mass. On ultrasonographic examination, this mass was identified as a large fluid-filled cavity in place of the right pancreatic duct and involved the pancreatic and accessory pancreatic ducts. A small echoic cavity was observed in the left pancreatic lobe. Serous fluid was collected from the large cavity. On cytology, the small cavity was consistent with an abscess. A partial left pancreatectomy was performed to remove the abscess. The large cavity was excised with the remnant of the right pancreatic lobe and body. After ligation of the pancreatic ducts, the left pancreatic duct was isolated and an end-to-side pancreaticoduodenostomy was performed. RESULTS The cat recovered without complications. Histological examination was consistent with chronic pancreatitis and peripheral inflammation. No evidence of postoperative pancreatic insufficiency was detected on clinical examination or laboratory findings. A focal ampulla-like dilation of the pancreatic duct was noted on ultrasonography, with no other complications at the anastomosis. The cat presented 225 days postoperatively with respiratory distress. Multiple nodules were identified throughout the lung parenchyma on radiographs. Abnormalities on ultrasonographic examination included an enlarged liver infiltrated with nodules. Due to poor prognosis, the cat was euthanized. Final histopathological diagnosis was diffuse carcinoma. CONCLUSION Pancreaticoduodenostomy restored pancreaticointestinal continuity after extensive pancreatectomy involving the pancreatic ducts and resulted in long-term survival in the cat reported here.
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Affiliation(s)
- Benoît Cruciani
- Department of Surgery, Small Animal, Veterinary Hospital Frégis, Arcueil, France
| | - Chloé Touzet
- Department of Surgery, Small Animal, Veterinary Hospital Frégis, Arcueil, France
| | - Elisabeth Robin
- Department of Surgery, Small Animal, Veterinary Hospital Frégis, Arcueil, France
| | - Camille Bismuth
- Department of Surgery, Small Animal, Veterinary Hospital Frégis, Arcueil, France
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Surjan RC, Basseres T, Makdissi FF, Machado MAC, Ardengh JC. LAPAROSCOPIC UNCINATECTOMY: A MORE CONSERVATIVE APPROACH TO THE UNCINATE PROCESS OF THE PANCREAS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2018; 30:147-149. [PMID: 29257853 PMCID: PMC5543796 DOI: 10.1590/0102-6720201700020015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/07/2017] [Indexed: 01/10/2023]
Abstract
Background: The isolate resection of the uncinate process of the pancreas is a rarely described procedure but is an adequate surgery to treat benign and low grade malignancies of the uncinate process of the pancreas. Aim: To detail laparoscopic uncinatectomy technique and present the initial results. Method: Patient is placed in supine position with the surgeon between legs. Three 5-mm, one 10-mm and one 12-mm trocars were used to perform the isolated resection of the uncinate process of the pancreas. Parenchymal transection is performed with harmonic scalpel. A hemostatic absorbable tissue is deployed over the area previously occupied by the uncinate process. A Waterman drain is placed. Result: This procedure was applied to an asymptomatic 62-year-old male with biopsy proven low grade neuroendocrine tumor of the pancreatic uncinate process. A laparoscopic pancreaticoduodenectomy was proposed. During the initial surgical evaluation, intraoperative sonography was performed and disclosed that the lesion was a few millimeters away from the Wirsung. The option was to perform a laparoscopic uncinatectomy. Postoperative period until full recovery was swift and uneventful. Conclusion: Laparoscopic uncinatectomy is a safe and efficient procedure when performed by surgical teams with large experience in minimally invasive biliopancreatic procedures.
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Affiliation(s)
- Rodrigo Cañada Surjan
- Department of Surgery, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Tiago Basseres
- Department of Surgery, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Fabio Ferrari Makdissi
- Department of Surgery, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - José Celso Ardengh
- Department of Surgery, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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5
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Nakagohri T, Jolesz FA, Okuda S, Asano T, Kenmochi T, Kainuma O, Tokoro Y, Aoyama H, Lorensen WE, Kikinis R. Virtual Pancreatoscopy of Mucin-Producing Pancreatic Tumors. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10929089809149848] [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]
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6
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Hirota M, Kanemitsu K, Takamori H, Chikamoto A, Ohkuma T, Komori H, Miyanari N, Ishiko T, Baba H. Local pancreatic resection with preoperative endoscopic transpapillary stenting. Am J Surg 2007; 194:308-10; discussion 311-2. [PMID: 17693272 DOI: 10.1016/j.amjsurg.2007.01.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 01/20/2007] [Accepted: 01/20/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pancreatic fistula, although not common, can cause serious complications after pancreatectomy. During local pancreatectomy, injury to the main pancreatic duct (in addition to the accessory and side branch ducts) increases the risk of pancreatic fistula formation. Nonetheless, local pancreatic resection maintains the advantage of preserving pancreatic parenchyma. METHODS In this study, we reviewed the cases of 5 patients who underwent preoperative endoscopic transpapillary pancreatic stenting to help prevent refractory fistula development after local pancreatic resection. RESULTS Stenting was successful in all 5 patients, and none developed a refractory grade C postoperative pancreatic fistula. CONCLUSIONS These results suggest that in selected patients, preoperative endoscopic pancreatic stenting may be an effective prophylactic measure to lower the risk of refractory grade C fistula formation after local pancreatic resection.
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Affiliation(s)
- Masahiko Hirota
- Department of Gastroentelogical Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto-city, 860-0811 Japan
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7
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Miura F, Takada T, Amano H, Yoshida M, Toyota N, Wada K. Middle-segment-preserving pancreatectomy. J Am Coll Surg 2007; 204:720-2. [PMID: 17382235 DOI: 10.1016/j.jamcollsurg.2007.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Revised: 12/15/2006] [Accepted: 01/02/2007] [Indexed: 12/21/2022]
Affiliation(s)
- Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
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8
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Yamaguchi T, Ishihara T, Saisho H. WHAT KIND OF BENEFIT DO WE EXPECT FOR PERORAL PANCREATOSCOPY IN THE DIAGNOSIS OF INTRADUCTAL PAPILLARY MUCINOUS TUMOR OF THE PANCREAS? Dig Endosc 2006. [DOI: 10.1111/j.1443-1661.2006.00628.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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9
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Miura F, Takada T, Asano T, Kenmochi T, Ochiai T, Amano H, Yoshida M. Hemodynamic changes of splenogastric circulation after spleen-preserving pancreatectomy with excision of splenic artery and vein. Surgery 2005; 138:518-22. [PMID: 16213907 DOI: 10.1016/j.surg.2005.04.020] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Revised: 04/21/2005] [Accepted: 04/22/2005] [Indexed: 12/31/2022]
Abstract
BACKGROUND The safety of spleen conservation without preservation of the splenic artery and vein was proved on the basis of short-term observation, but the long-term results of this procedure have been uncertain. To clarify the hemodynamic changes of splenogastric circulation of patients undergoing spleen-preserving pancreatectomy with excision of the splenic artery and vein, we retrospectively analyzed patient outcome with particular reference to the assessment of hemodynamic changes of splenogastric circulation. METHODS Ten patients who had undergone spleen-preserving pancreatectomy with excision of the splenic artery and vein were retrospectively analyzed. In all patients both the short gastric and left gastroepiploic arteries and veins were preserved. All patients were observed for a minimum of 52 months. Collateral venous pathways were evaluated by computed tomography and endoscopy. RESULTS Early complications such as splenic infarction and atrophy did not occur in any of the patients, but computed tomography revealed perigastric varices in 7 patients (70%) and submucosal varices in 2 patients (20%). Endoscopy showed gastric varices in 2 patients in whom submucosal gastric varices were identified on computed tomography. Gastrointestinal bleeding from gastric varices occurred in 1 patient. In 1 patient without gastric varices, a gastrorenal shunt was demonstrated on computed tomography. CONCLUSIONS This study confirmed that gastric varices frequently occurred in patients who underwent spleen-preserving pancreatectomy with excision of the splenic artery and vein.
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Affiliation(s)
- Fumihiko Miura
- Department of Surgery, Teikyo University, School of Medicine, Tokyo, Japan
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10
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Kono T, Okazumi S, Mochizuki R, Ootsuki K, Shinotou K, Matsuzaki H, Natsume T, Kenmochi T, Nakagohri T, Asano T, Ochiai T. Clinical application of (11)C-methionine positron emission tomography for evaluation of pancreatic function. Pancreas 2002; 25:20-5. [PMID: 12131766 DOI: 10.1097/00006676-200207000-00007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
INTRODUCTION In recent years, it has become increasingly necessary to evaluate pancreatic function after pancreatectomy, but few precise methods are available. AIMS To evaluate different surgical techniques for pancreatectomy in terms of the preservation of pancreatic function by (11)C-methionine positron emission tomography (PET), which determines amino acid metabolism in the pancreas. METHODOLOGY The study included 33 pancreatectomy cases: 5 of distal pancreatectomy, 5 of pancreaticoduodenectomy, 10 of pylorus-preserving pancreaticoduodenectomy, 7 of duodenum-preserving pancreatic head resection, and 6 of inferior pancreatic head resection. The method was as follows. Approximately 370 MBq (11)C-methionine was intravenously injected. Cross-sectional imaging of the pancreas was performed by PET after 30 minutes. The images obtained were used to determine the radioactivity concentration in the pancreas. By adjustment of the radioactivity concentration for body weight and dosage, the differential absorption ratio could be determined to indicate the level of accumulation in the pancreas. Each surgical method used was evaluated on the basis of the differential absorption ratio. Postoperative total pancreatic accumulation was divided by preoperative level to calculate the total preserved pancreatic function rate (TPPFR), and postoperative local pancreatic accumulation was divided by preoperative level to calculate the local preserved pancreatic function rate (LPPFR). These rates were then compared for the individual techniques used. RESULTS The results indicated that TPPFR and LPPFR were 61.2 +/- 20.0% and 114.6 +/- 29.4% for distal pancreatectomy (n = 5), 31.8 +/- 20.0% and 58.7 +/- 30.0% for pancreaticoduodenectomy (n = 5), 21.6 +/- 14.7% and 58.4 +/- 29.8% for pylorus-preserving pancreaticoduodenectomy (n = 10), 47.9 +/- 35.5% and 67.7 +/- 30.6% for duodenum-preserving pancreatic head resection (n = 7), and 48.1 +/- 29.5% and 83.9 +/- 30.5% for inferior pancreatic head resection (n = 6). TPPFR was highest in distal pancreatectomy cases. Among the pancreatic head resections, TPPFR was quite high for both inferior pancreatic head resection and duodenum-preserving pancreatic head resection. In contrast, TPPFR for pancreaticoduodenectomy and pylorus-preserving pancreaticoduodenectomy was quite low. LPPFR was highest for distal pancreatectomy and only slightly lower for inferior pancreatic head resection. In contrast, LPPFR was markedly lower for pancreaticoduodenectomy and pylorus-preserving pancreaticoduodenectomy. CONCLUSION In conclusion, this method using (11)C-methionine PET is clearly useful for the evaluation of pancreatic function after pancreatectomy.
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Affiliation(s)
- Tsuguaki Kono
- Second Department of Surgery, Chiba University School of Medicine, Chiba, Japan.
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11
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Sakamoto Y, Tanaka N, Nagai M, Nobori M, Otani T, Makuuchi M. Anterior segmentectomy of the pancreatic head for islet cell tumors. Pancreas 2002; 24:317-9. [PMID: 11893944 DOI: 10.1097/00006676-200204000-00019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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12
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Pedrazzoli S, Sperti C, Pasquali C. Pancreatic head resection for noninflammatory benign lesions of the head of the pancreas. Pancreas 2001; 23:309-15. [PMID: 11590328 DOI: 10.1097/00006676-200110000-00013] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Duodenum-preserving pancreatic head resection (DPPHR) has been safely performed in patients with chronic pancreatitis. The procedure has rarely been used to remove benign or borderline lesions of the head of the pancreas. AIMS To review our experience with 13 patients who underwent DPPHR and to review reports in the literature on the same subject. METHODOLOGY From October 1991 to September 2000, 13 patients underwent DPPHR to resect endocrine pancreatic tumors (n = 4), beta cell hyperplasia (n = 1), pancreatic pseudocysts (n = 2), serous cystadenomas (n = 3), congenital (n = 1) and choledochal (n = 1) cysts, and intraductal papillary mucinous tumor (n = 1). The Kocher maneuver was performed in seven patients (group 1) and avoided in six (group 2). Type 1, 2, and 3 DPPHR were defined depending on the amount of pancreatic tissue left at the inner surface of the duodenum. Ten patients underwent evaluation that included an oral glucose tolerance test and exocrine pancreatic function test. RESULTS The mortality rate was zero; the complication rate was 69%. Patients in whom the Kocher maneuver was not performed (group 2) experienced fewer complications, shorter stay on nasogastric tube and abdominal drain(s), and earlier water intake and discharge. Type of DPPHR did not influence the postoperative course. One patient died 3 months after surgery of unrelated disease. Twelve patients were alive and well 2 months to 8 years after surgery. CONCLUSION DPPHR is a low-risk procedure in patients with benign or borderline noninflammatory lesions of the head of the pancreas in whom pylorus-preserving pancreaticoduodenectomy is otherwise indicated. Whenever possible, the Kocher maneuver should be avoided.
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Affiliation(s)
- S Pedrazzoli
- Department of Medical and Surgical Sciences, Surgical Semeiotics, University of Padova, Italy.
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13
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Sakamoto Y, Nagai M, Tanaka N, Nobori M, Tsukamoto T, Nokubi M, Suzuki Y, Makuuchi M. Anatomical segmentectomy of the head of the pancreas along the embryological fusion plane: a feasible procedure? Surgery 2000; 128:822-31. [PMID: 11056446 DOI: 10.1067/msy.2000.109611] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Less extensive resection of the head of the pancreas has been the procedure of choice recently for low-grade malignant neoplasms. The anatomical detail of the head of the pancreas is currently insufficient for segmental resection along the embryological fusion plane. METHODS The anatomy of the head of the pancreas was analyzed in 31 consecutive autopsy specimens. An anterior (n = 10) or posterior (n = 10) segmentectomy of the head of each pancreas was performed along the macroscopically found fusion plane. The pancreatic arteries, the portal vein, the bile duct, and the pancreatic duct were visualized by injecting 3 silicon dyes of different colors. Another 11 specimens were examined by pancreatography before and after anterior (n = 5) or posterior (n = 6) segmentectomy. Eight of these 11 specimens were stained immunohistochemically to reveal the distribution of pancreatic polypeptide cells after segmentectomy. RESULTS The cleavage between the anterior and posterior segments was discovered at the anterior inferior edge or at the posterior superior edge of the head of the pancreas. Anterior segmentectomy was accomplished while preserving the anterior and posterior pancreaticoduodenal arcades and the lower bile duct in the posterior segment. Posterior segmentectomy involved the removal of the lower bile duct and the posterior pancreaticoduodenal arcades. Pancreatography after segmentectomy showed the division of the ducts of Wirsung and Santorini with the peripheral branches. The immunohistochemical boundary of pancreatic polypeptide cells coincided with the surgical plane. These results showed the anterior and posterior segments were originated from the embryologically dorsal and ventral primordia, respectively. CONCLUSIONS The current anterior or posterior segmentectomy of the head of the pancreas corresponded to the resection of the embryologically dorsal or ventral primordium, respectively. Anterior segmentectomy of the head of the pancreas might be a clinically applicable procedure; however, posterior segmentectomy involving the resection of the lower bile duct may be impractical.
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Affiliation(s)
- Y Sakamoto
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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14
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Yamaguchi T, Hara T, Tsuyuguchi T, Ishihara T, Tsuchiya S, Saitou M, Saisho H. Peroral pancreatoscopy in the diagnosis of mucin-producing tumors of the pancreas. Gastrointest Endosc 2000; 52:67-73. [PMID: 10882965 DOI: 10.1067/mge.2000.105721] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Mucin-producing tumor of the pancreas is an increasingly recognized clinical entity. However, the differentiation of benign from malignant mucin-producing tumors of the pancreas is challenging. Peroral pancreatoscopy as recently developed may have potential for the diagnosis of mucin-producing tumors of the pancreas. METHODS The subjects were 41 patients with clinically diagnosed mucin-producing tumors of the pancreas, 40 of whom underwent surgical resection. Autopsy findings were available in another patient with unresectable disease. Histologically, hyperplasia was identified in 3 patients, mildly atypical adenoma in 11, severely atypical adenoma in 16, and adenocarcinoma in 11. Peroral pancreatoscopy was performed before surgery or pathologic examination. The findings were retrospectively evaluated and compared with the histopathologic diagnosis. RESULTS Pancreatoscopic observation was successful in 30 patients (73.2%). Elevated lesions were identified in 22 (73.3%). Villous or vegetative elevations and red color markings were frequently found in severely atypical adenoma or adenocarcinoma. Tumor location (main or branch duct type) did not correlate with survival after resection. Partial resection was performed in 7 of 30 patients with nonmalignant tumors and resulted in favorable outcomes. CONCLUSION Peroral pancreatoscopy can be used to differentiate benign mucin-producing tumors of the pancreas (hyperplasia and mildly atypical adenoma) from the more dysplastic lesions (severely atypical adenoma and adenocarcinoma) and may provide useful information for determining the type of surgery to be performed.
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MESH Headings
- Adenocarcinoma/metabolism
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adenoma/metabolism
- Adenoma/mortality
- Adenoma/pathology
- Adenoma/surgery
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Chi-Square Distribution
- Diagnosis, Differential
- Endoscopy, Digestive System
- Female
- Humans
- Male
- Middle Aged
- Mucins/metabolism
- Pancreatectomy/methods
- Pancreatic Neoplasms/metabolism
- Pancreatic Neoplasms/mortality
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Probability
- Prognosis
- Retrospective Studies
- Sensitivity and Specificity
- Survival Rate
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Affiliation(s)
- T Yamaguchi
- First Department of Medicine, Chiba University School of Medicine, Chiba, Japan
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15
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Nakagohri T, Kenmochi T, Kainuma O, Tokoro Y, Kobayashi S, Asano T. Inferior head resection of the pancreas for intraductal papillary mucinous tumors. Am J Surg 2000; 179:482-4. [PMID: 11004335 DOI: 10.1016/s0002-9610(00)00394-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with intraductal papillary mucinous tumor have a favorable prognosis after surgical treatment. When this neoplasm is located in the head of the pancreas, resection has conventionally required pancreatoduodenectomy. Although pancreatoduodenectomy can now be performed with a low mortality rate, morbidity still occurs frequently. METHODS Between November 1982 and January 1999, 38 intraductal papillary mucinous tumors of the pancreas were resected at the Chiba University Hospital. Seven patients (18%) underwent inferior head resection of the pancreas. In this preliminary study, the operative technique is presented, and its efficacy in improvement of quality of life is evaluated. RESULTS Patients with intraductal papillary mucinous tumor underwent resection with no perioperative mortality. After discharge from hospital, 6 patients who underwent inferior head resection were still alive without recurrent disease after a median follow-up of 3 years. However, 1 patient developed peritoneal dissemination and died 18 months after inferior head resection. Patients had regained 98% of preoperative weight 1 year after inferior head resection. N-benzoyl-L-tyrosyl-p-amino-benzoic acid (BT-PABA) excretion test showed the same value before (73%) and after (73%) inferior head resection (n = 7). Pancreatic fistulas occurred more frequently after inferior head resection (38%), but the incidence of major complications was similar between inferior head resection and other types of pancreatic head resection. CONCLUSIONS Pancreatic function was well preserved, and patients regained 98% of preoperative weight after inferior head resection of the pancreas. The authors concluded that the limited involvement of intraductal papillary mucinous tumors enables the surgeons to perform inferior head resection of the pancreas.
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Affiliation(s)
- T Nakagohri
- Second Department of Surgery, Chiba University School of Medicine, Chiba, Japan
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16
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Abstract
Recent innovations in the field of ultrafast MR imaging have increased the robustness of MR cholangiopancreatography (MRCP). Its complete noninvasiveness and flexible physiological approaches in detecting pancreaticobiliary pathologic conditions are gaining the acceptance of many clinicians. The procedure is also safer and more comfortable both for physicians and patients compared with direct pancreatography or cholangiography. Because of its cost effectiveness and safety, optimized MRCP technologies will gradually replace the diagnostic use of endoscopic retrograde cholangiopancreatography (ERCP). It is also notable that MRCP techniques can be used to obtain physiological/dynamic information that ERCP cannot provide. This article addresses recent advances in MRCP from technological and clinical aspects, focusing on its unique features as a hydrographic technique, and also refers to its limitations.
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Affiliation(s)
- Y Takehara
- Department of Radiology, Hamamatsu University School of Medicine, Japan
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Nakagohri T, Kenmochi T, Kainuma O, Tokoro Y, Asano T. Intraductal papillary mucinous tumors of the pancreas. Am J Surg 1999; 178:344-7. [PMID: 10587197 DOI: 10.1016/s0002-9610(99)00192-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND An increasing number of intraductal papillary mucinous tumors of the pancreas have been reported in recent years. The indolent character and favorable prognosis of this neoplasm have been described. METHODS Intraductal papillary mucinous tumors were classified into main duct type (n = 8) and branch type (n = 28) according to the dominant location of the tumor. This single-institute study examined the clinicopathological features and outcome after surgical resection in patients with intraductal papillary mucinous tumors. RESULTS The gender, age, tumor size, and prognosis were quite similar for the main duct type and branch type groups. Branch type tumors were more frequently located in the head of the pancreas than were main duct type tumors. Histological examination revealed that 88% of main duct type tumors were adenocarcinomas; however, only 46% of branch type tumors were adenocarcinomas. Five-year survival rates for the patients with all main duct type tumors (n = 8), main duct type adenocarcinoma (n = 7), all branch type tumors (n = 28), and branch duct adenocarcinoma (n = 13) were 100%, 100%, 90.6%, and 90.9%, respectively. CONCLUSIONS Intraductal papillary mucinous tumors had a favorable prognosis after surgical treatment. A curative pancreatectomy should be indicated for this localized malignant tumor.
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Affiliation(s)
- T Nakagohri
- Second Department of Surgery, Chiba University School of Medicine, Japan
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Takahashi S, Akita K, Goseki N, Sato T. Spatial arrangement of the pancreatic ducts in the head of the pancreas with special reference to the branches of the uncinate process. Surgery 1999. [DOI: 10.1016/s0039-6060(99)70263-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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