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Zu G, Chen W, Wu D, Zhang Y, Chen X. Clinical outcomes of minimally invasive duodenum-preserving pancreatic head resection. BMC Surg 2023; 23:288. [PMID: 37735367 PMCID: PMC10512602 DOI: 10.1186/s12893-023-02170-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The procedure of total duodenum-preserving pancreatic head resection (DPPHRt) has been reported frequently, but rare in minimally invasive procedure, especially robotic-assisted operation. Here we share our experience and analyze the clinical outcomes of minimally invasive DPPHRt in the treatment of benign lesions or low-grade malignant tumors of the pancreatic head in this study. MATERIALS AND METHODS From October 2016 to January 2022, three patients received robot-assisted DPPHRt(RA-DPPHRt), and seventeen patients received laparoscopic DPPHRt(LDPPHRt). Data were retrospectively collected in terms of demographic characteristics (age, gender, body mass index, and pathological diagnosis), intraoperative variables (operative time, estimated blood loss), and post-operative variables (post-operative hospital stay, and complications). RESULTS All 20 patients received minimally invasive total duodenum-preserving pancreatic head resection successfully without conversion, including 8 males and 12 females. Pathological diagnosis suggested 1 case of serous cystadenoma (SCA), 4 cases of intraductal papillary mucinous neoplasm (IPMN) ,5 cases of mucinous cystic neoplasm (MCN), 4 cases of pancreatic neuroendocrine neoplasm (PNET), 2 cases of chronic pancreatitis (CP),4 case of solid pseudopapillary tumor (SPT). The average operation time was (285.35 ± 95.13 min), ranging from 95 to 420 min. The average estimate blood loss was (196.50 ± 174.45ml) ,ranging from 10 to 600ml.The average post-operative hospital stay was(20.90 ± 14.44days),ranging from 8 to 54 days. Postoperative complications occurred in 10 patients (50%). A total of 5 patients (20%) suffered grade B or C pancreatic fistula. Two patients (10%) suffered from biliary fistula. Two patients (10%) suffered from delayed gastric emptying. One patient (5%) suffered from abdominal bleeding. The 90-day mortality was 0. No patient was observed tumor recurrence and new-onset diabetes but one developed diarrhea. CONCLUSION RA-DPPHRt or LDPPHRt provided a minimally invasive approach with good organ-preservation for patients with benign and low-grade malignant pancreatic head tumor. It is only recommended to be performed in high-volume pancreatic centers by experienced pancreatic surgeons.
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Affiliation(s)
- Guangchen Zu
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China
| | - Weibo Chen
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China
| | - Di Wu
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China
| | - Yue Zhang
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China
| | - Xuemin Chen
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China.
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Xia Z, Zhao S, Gao X, Sun H, Yang F, Zhu H, Gao H, Lu J, Zhou X. Short-term clinical outcomes of laparoscopic duodenum-preserving pancreatic head resection for the management of pancreatic-head cystic neoplasms. BMC Surg 2023; 23:104. [PMID: 37118776 PMCID: PMC10148395 DOI: 10.1186/s12893-023-01985-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/04/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND In this study, we aimed to investigate the short-term clinical outcomes of laparoscopic duodenum-preserving pancreatic-head resection (LDPPHR) for the management of pancreatic-head cystic neoplasms. METHODS This retrospective study included 60 patients who were treated with pancreatic-head cystic neoplasms at the Shandong Provincial Hospital Affiliated to Shandong First Medical University from December 2019 to July 2022. RESULTS No significant difference was found between the two groups in terms of the baseline and pathological characteristics of patients (P > 0.05). The postoperative exhaust time was shorter in the LDPPHR group compared with the laparoscopic pancreaticoduodenectomy (LPD) group (2 (2 and 4) vs. 4 (3 and 5) days; P = 0.003). No significant difference was found between the two groups in terms of operative time, estimated blood loss, intraoperative transfusion, hemoglobin levels on the first postoperative day, total bilirubin before discharge, direct bilirubin before discharge, postoperative hospital stay, postoperative pancreatic fistula, bile leakage, hemorrhage, peritoneal effusion, abdominal infection, delayed gastric emptying, interventional embolization hemostasis, reoperation, and 30-day readmission (P > 0.05). No conversion and 90-day mortality were found in the two groups. The LDPPHR group showed a higher 3-month postoperative PNI, 6-month postoperative TG and 6-month postoperative BMI than the LPD group (P < 0.05). CONCLUSIONS Compared with LPD, LDPPHR can decrease the postoperative exhaust time of patients, improve the short-term postoperative nutritional status, and does not decrease the safety of the perioperative period.
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Affiliation(s)
- Zhaozhi Xia
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiseven Road, Huaiyin District, Jinan, China
| | - Shuchao Zhao
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiseven Road, Huaiyin District, Jinan, China
| | - Xin Gao
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiseven Road, Huaiyin District, Jinan, China
| | - Hongrui Sun
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiseven Road, Huaiyin District, Jinan, China
| | - Faji Yang
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiseven Road, Huaiyin District, Jinan, China
| | - Huaqiang Zhu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiseven Road, Huaiyin District, Jinan, China
| | - Hengjun Gao
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiseven Road, Huaiyin District, Jinan, China
| | - Jun Lu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiseven Road, Huaiyin District, Jinan, China
| | - Xu Zhou
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiseven Road, Huaiyin District, Jinan, China.
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3
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Guo S, Zhou Q, Yang J, Tao J, Zhang J, Wang H. Duodenum-preserving pancreatic head resection compared to pancreaticoduodenectomy: A systematic review and network meta-analysis of surgical outcomes. Front Surg 2023; 10:1107613. [PMID: 37066008 PMCID: PMC10090510 DOI: 10.3389/fsurg.2023.1107613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
ObjectivesIn this systemic review and network meta-analysis, we investigated pancreaticoduodenectomy (PD), pylorus-preserving pancreaticoduodenectomy (PPPD), and different modifications of duodenum-preserving pancreatic head resection (DPPHR) to evaluate the efficacy of different surgical procedures.MethodsA systemic search of six databases was conducted to identify studies comparing PD, PPPD, and DPPHR for treating pancreatic head benign and low-grade malignant lesions. Meta-analyses and network meta-analyses were performed to compare different surgical procedures.ResultsA total of 44 studies were enrolled in the final synthesis. Three categories of a total of 29 indexes were investigated. The DPPHR group had better working ability, physical status, less loss of body weight, and less postoperative discomfort than the Whipple group, while both groups had no differences in quality of life (QoL), pain scale scores, and other 11 indexes. Network meta-analysis of a single procedure found that DPPHR had a larger probability of best performance in seven of eight analyzed indexes than PD or PPPD.ConclusionDPPHR and PD/PPPD have equal effects on improving QoL and pain relief, while PD/PPPD has more severe symptoms and more complications after surgery. PD, PPPD, and DPPHR procedures exhibit different strengths in treating pancreatic head benign and low-grade malignant lesions.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022342427.
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Affiliation(s)
- Shixiang Guo
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing, China
- Chongqing School, University of Chinese Academy of Sciences, Chongqing, China
| | - Qiang Zhou
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing, China
| | - Jiali Yang
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing, China
| | - Junyu Tao
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing, China
| | - Junfeng Zhang
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing, China
| | - Huaizhi Wang
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing, China
- Correspondence: Huaizhi Wang
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Dmitriev I, Oganesyan M, Popova A, Orlov E, Sinelnikov M, Zharikov Y. Anatomical basis for pancreas transplantation via isolated splenic artery perfusion: A literature review. World J Clin Cases 2022; 10:12844-12853. [PMID: 36569006 PMCID: PMC9782932 DOI: 10.12998/wjcc.v10.i35.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/10/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
The variability of vascular anatomy of the pancreas underlines the difficulty of its transplantation. Research regarding the consistency of anatomical variations shows splenic arterial dominance in most cases. This can significantly improve transplantation success. A systematic literature review was performed according to the quality standards described in the AMSTAR measurement tool and the PRISMA guidelines. We valuated existing literature regarding the vascularization and blood perfusion patterns of the pancreas in terms of dominance and variability. The collected data was independently analyzed by two researchers. Variance of vascular anatomy was seen to be underreported in literature, though significant findings have been included and discussed in this study, providing valuable insight into the dynamics of pancreatic perfusion and feasibility of transplantation on several different supplying arteries. The splenic artery (SA) has a high percentage of consistency in all found studies (over 90%). High frequency of anastomoses between arterial pools supplying the pancreas can mediate sufficient blood supply through a dominant vessel, such as the SA, which is present in most cases. Pancreatic transplantation with isolated SA blood supply can provide sufficient arterial perfusion of the pancreas for stable transplant viability due to high anatomical consistency of the SA and vast communications with other arterial systems.
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Affiliation(s)
- Ilya Dmitriev
- Department of Pancreas and Kidney Transplantation, N.V. Sklifosovsky Research Institute for Emergency Care, Moscow 107045, Russia
| | - Marine Oganesyan
- Department of Human Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
| | - Antonina Popova
- Department of Human Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
| | - Egor Orlov
- Department of Human Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
| | - Mikhail Sinelnikov
- Department of Human Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
- Department of Oncology, Radiotherapy and Reconstructive Surgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119048, Russia
- Laboratory of clinical morphology, Research Institute of Human Morphology, Moscow 117418, Russia
| | - Yury Zharikov
- Department of Human Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
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Laparoscopic duodenum-preserving pancreatic head resection: a narrative review. JOURNAL OF PANCREATOLOGY 2021. [DOI: 10.1097/jp9.0000000000000080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kagawa K, Kubota K, Kurita Y, Takagi Y, Ishii K, Hasegawa S, Iwasaki A, Sato T, Fujita Y, Kato S, Watanabe S, Sekino Y, Hosono K, Nakajima A. Effect of preventive closure of the frenulum after endoscopic papillectomy: A prospective pilot study. J Gastroenterol Hepatol 2020; 35:374-379. [PMID: 31693767 DOI: 10.1111/jgh.14922] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/15/2019] [Accepted: 10/29/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM The usefulness of preventive closure of the frenulum after endoscopic papillectomy (EP) could reduce bleeding. The feasibility and safety of clipping were evaluated in this prospective pilot study. METHODS This study involved 40 consecutive patients who underwent preventive closure of the frenulum by clipping just after EP. The outcome data were compared with those of the previous 40 patients in whom no preemptive closure had been performed (no-closure group) (UMIN000014783). Additionally, the bleeding sites were examined. RESULTS The clipping procedure was successful in all patients. As compared to the no-closure group, the rate of bleeding (P = 0.026) and period of hospital stay (P < 0.001) were significantly reduced in the closure group. There was no difference in the procedure time between the two groups. Furthermore, the incidence rates of pancreatitis and perforation were comparable in the two groups. The bleeding was noted in the frenulum area rather than at any other site in 90.9% of cases. CONCLUSION Preventive closure of the frenulum after EP is an effective, safe, rational, and economical method to reduce the incidence of delayed bleeding, without prolonging the procedure time or increasing the risk of post-procedure pancreatitis perforation.
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Affiliation(s)
- Koichi Kagawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kensuke Kubota
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Yusuke Kurita
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Yuri Takagi
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Ken Ishii
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Sho Hasegawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Akito Iwasaki
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Takamitsu Sato
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Yuji Fujita
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Shingo Kato
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Seitaro Watanabe
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Yusuke Sekino
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kunihiro Hosono
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Pinchuk AV, Dmitriev IV, Anisimov YA, Storozhev RV, Balkarov AG, Kondrashkin AS, Khodilina IV, Muslimov RS. Pancreas transplantation with isolated splenic artery blood supply - Single center experience. Asian J Surg 2019; 43:315-321. [PMID: 31301933 DOI: 10.1016/j.asjsur.2019.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/13/2019] [Accepted: 06/25/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The blood supply of the native pancreas by three arterial lines from the celiac trunk system (splenic artery and common hepatic artery) and the superior mesenteric artery forces surgeons to perform vascular reconstruction to provide sufficient intra-organ blood flow into the graft. The purpose of our study was to assess the possibility of pancreas transplantation with an isolated splenic artery blood supply. METHODS From January 2012 to July 2018, simultaneous pancreas-kidney transplantation (SPKT) was performed in 21 patients. Gender: male - 11 (52,4%), female 10 (47,6%). Recipients aged 26 to 54, the median age was 38 [34; 42] years. In 6 (28,6%) recipients, the organ perfusion was carried out through the splenic artery alone; in the rest, it was performed through the splenic and inferior pancreaticoduodenal artery exiting from the superior mesenteric artery of the graft. The transplant function, the quality of carbohydrate metabolism compensation, the objective characteristics of intra-organ blood flow was assessed. RESULTS There were no statistically significant differences in the volume blood flow characteristics revealed by CT-perfusion and laboratory data in the study groups. CONCLUSIONS Based on the assessment of the function and quality of blood supply to the transplant, the possibility of performing pancreas transplantation with an isolated splenic artery blood supply had been proved.
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Affiliation(s)
- Alexey V Pinchuk
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Kidney and Pancreas Transplantation Department, Moscow, Russia; Moscow State University of Medicine and Dentistry, Department of Transplantation and Artificial Organs, Moscow, Russia; Scientific Research Institute of Healthcare Organization and Medical Management, Moscow, Russia.
| | - Ilya V Dmitriev
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Kidney and Pancreas Transplantation Department, Moscow, Russia
| | - Yuriy A Anisimov
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Kidney and Pancreas Transplantation Department, Moscow, Russia.
| | - Roman V Storozhev
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Kidney and Pancreas Transplantation Department, Moscow, Russia
| | - Aslan G Balkarov
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Kidney and Pancreas Transplantation Department, Moscow, Russia
| | - Aleksandr S Kondrashkin
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Kidney and Pancreas Transplantation Department, Moscow, Russia
| | - Irina V Khodilina
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Department of Ultrasound Diagnostics, Moscow, Russia
| | - Rustam Sh Muslimov
- N.V.Sclifosovsky Research Institute for Emergency Medicine, Department of Emergency Radiology, Moscow, Russia
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Pinchuk AV, Anisimov IA, Dmitriev IV, Storozhev RV, Balkarov AG, Muslimov RS, Khodilina IV. [Pancreas transplantation with isolated blood supply through the splenic artery]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:125-129. [PMID: 30994618 DOI: 10.33529/angio2019117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In multiple organ procurement, taking into consideration certain peculiarities of the vascular architectonics of the celiac trunk or an iatrogenic injury to the superior mesenteric artery, it is impossible to perform standard arterial reconstruction of a pancreas transplant with the use of a Y-shaped vascular allograft. This results in refusal from transplanting a potentially suitable organ. The purpose of our study was to assess the possibility of transplantation of the pancreatoduodenal complex with isolated blood supply via the splenic artery. Between January 2008 and November 2016, transplantation of the pancreas was carried out in a total of 20 patients (9 men and 11 women aged from 26 to 40 years, mean age 37.2±5.6 years). Depending on the number of the major arteries supplying the pancreas, the patients were divided into 2 groups. No statistically significant between-group differences in the parameters of volumetric blood flow determined by means of CT perfusion, in the majority of laboratory findings or therapeutic outcomes were revealed. Based on assessment of the function and quality of pancreatic blood supply, we proved feasibility of transplantation of the pancreatoduodenal complex with isolated blood supply through the splenic artery.
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Affiliation(s)
- A V Pinchuk
- Department of Kidney and Pancreas Transplantation, Research Institute of Emergency Medicine named after N.V. Sklifosovsky under the Moscow Health Care Department, Moscow, Russia
| | - Iu A Anisimov
- Department of Kidney and Pancreas Transplantation, Research Institute of Emergency Medicine named after N.V. Sklifosovsky under the Moscow Health Care Department, Moscow, Russia
| | - I V Dmitriev
- Department of Kidney and Pancreas Transplantation, Research Institute of Emergency Medicine named after N.V. Sklifosovsky under the Moscow Health Care Department, Moscow, Russia
| | - R V Storozhev
- Department of Kidney and Pancreas Transplantation, Research Institute of Emergency Medicine named after N.V. Sklifosovsky under the Moscow Health Care Department, Moscow, Russia
| | - A G Balkarov
- Department of Kidney and Pancreas Transplantation, Research Institute of Emergency Medicine named after N.V. Sklifosovsky under the Moscow Health Care Department, Moscow, Russia
| | - R Sh Muslimov
- Department of Radiodiagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky under the Moscow Health Care Department, Moscow, Russia
| | - I V Khodilina
- Department of Ultrasound Methods of Diagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky under the Moscow Health Care Department, Moscow, Russia
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Beger HG, Mayer B, Poch B. Parenchyma-sparing, local pancreatic head resection for premalignant and low-malignant neoplasms - A systematic review and meta-analysis. Am J Surg 2018; 216:1182-1191. [PMID: 30366596 DOI: 10.1016/j.amjsurg.2018.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/18/2018] [Accepted: 10/05/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Parenchyma-sparing, local pancreatic head resection, but not pancreaticoduodenectomy (PD) preserves tissue and maintains the pancreatic metabolic functions. METHODS PubMed/Medline, Embase, and Cochrane library collections were systematically searched. Twenty-six cohort studies with 523 cumulative patients, who underwent duodenum-sparing pancreatic head resection (DPPHR), were retrieved. The meta-analysis was based on 14 controlled studies. RESULTS In total, 338 patients suffered cystic neoplasms and 59 PNETs, IPMN-174, MCN-43 and SPN-23 patients. Eighty-one patients (15.5%) histo-pathologically displayed a low-malignant tumor, of which 27 were carcinoma in-situ. Tumor recurrence was observed after a mean follow-up of 47.1 months in 11 patients. In-hospital and late mortality after DPPHR was 0.6% and 1.7%, respectively. The meta-analysis was based on 318 DPPHR compared to 404 PD patients. DPPHR was performed for premalignant neoplasm and PNET in 164 and 46 patients, and PD in 181 and 46 patients, respectively. Events of recurrence displayed no statistically significant difference between the DPPHR and PD groups. CONCLUSION DPPHR is associated with oncologically complete tumor resection for patients suffering premalignant IPMN, MCN, or SPN and for low-risk cancer.
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Affiliation(s)
- Hans G Beger
- C/o University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany; Center for Oncologic, Endocrine and Minimal Invasive Surgery, Donau-Klinikum, Neu-Ulm, Germany.
| | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, University of Ulm, Germany
| | - Bertram Poch
- Center for Oncologic, Endocrine and Minimal Invasive Surgery, Donau-Klinikum, Neu-Ulm, Germany
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Szuák A, Németh K, Korom C, Gáti E, Karlinger K, Harsányi L, Nemeskéri Á. Pancreaticoduodenal arterial arcades: Their dominance and variations-their potential clinical relevance. Clin Anat 2018; 31:544-550. [DOI: 10.1002/ca.23063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/05/2018] [Accepted: 02/13/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Andás Szuák
- Department of Anatomy, Histology and Embryology; Semmelweis University Budapest; Budapest, Tűzoltó utca 58 H-1094 Hungary
| | - Károly Németh
- Department of Anatomy, Histology and Embryology; Semmelweis University Budapest; Budapest, Tűzoltó utca 58 H-1094 Hungary
| | - Csaba Korom
- Department of Radiology; Semmelweis University Budapest; Budapest, Üllői út 78a H-1082 Hungary
| | - Endre Gáti
- 1st Department of Surgery; Semmelweis University Budapest; Budapest, Üllői út 78 H-1082 Hungary
| | - Kinga Karlinger
- Department of Radiology; Semmelweis University Budapest; Budapest, Üllői út 78a H-1082 Hungary
| | - László Harsányi
- 1st Department of Surgery; Semmelweis University Budapest; Budapest, Üllői út 78 H-1082 Hungary
| | - Ágnes Nemeskéri
- Department of Anatomy, Histology and Embryology; Semmelweis University Budapest; Budapest, Tűzoltó utca 58 H-1094 Hungary
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Parenchyma-Sparing, Limited Pancreatic Head Resection for Benign Tumors and Low-Risk Periampullary Cancer--a Systematic Review. J Gastrointest Surg 2016; 20:206-17. [PMID: 26525207 DOI: 10.1007/s11605-015-2981-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/08/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Parenchyma-sparing local extirpation of benign tumors of the pancreatic head provides the potential benefits of preservation of functional tissue and low postoperative morbidity. METHODS Medline/PubMed, Embase, and Cochrane library databases were surveyed for studies performing limited resection of the pancreatic head and resection of a segment of the duodenum and common bile duct or preservation of the duodenum and common bile duct (CBD). The systematic analysis included 27 cohort studies that reported on limited pancreatic head resections for benign tumors. In a subgroup analysis, 12 of the cohort studies were additionally evaluated to compare the postoperative morbidity after total head resection including duodenal segment resection (DPPHR-S) and total head resection conserving duodenum and CBD (DPPHR-T). RESULTS Three hundred thirty-nine of a total of 503 patients (67.4%) underwent total head resections. One hundred forty-seven patients (29.2%) of them underwent segmental resection of the duodenum and CBD (DPPHR-S) and 192 patients (38.2%) underwent preservation of duodenum and CBD. One hundred sixty-four patients experienced partial head resection (32.6%). The final histological diagnosis revealed in 338 of 503 patients (67.2%) cystic neoplasms, 53 patients (10.3%) neuroendocrine tumors, and 20 patients (4.0%) low-risk periampullary carcinomas. Severe postoperative complications occurred in 62 of 490 patients (12.7%), pancreatic fistula B + C in 40 of 295 patients (13.6%), resurgery was experienced in 2.7%, and delayed gastric emptying in 12.3%. The 90-day mortality was 0.4%. The subgroup analysis comparing 143 DPPHR-S patients with 95 DPPHR-T patients showed that the respective rates of procedure-related biliary complications were 0.7% (1 of 143 patients) versus 8.4% (8 of 95 patients) (p ≤ 0.0032), and rates of duodenal complications were 0 versus 6.3% (6 of 95 patients) (p ≤ 0.0037). DPPHR-S was associated with a higher rate of delay of gastric emptying compared to DPPHR-T (18.9 vs. 2.1%, p ≤ 0.0001). CONCLUSION Parenchyma-sparing, limited head resection for benign tumors preserves functional pancreatic and duodenal tissue and carries in terms of fistula B + C rate, resurgery, rehospitalization, and 90-day mortality a low risk of postoperative complications. A subgroup analysis exhibited after total pancreatic head resection that preserves the duodenum and CBD an association with a significant increase in procedure-related biliary and duodenal complications compared to total head resection combined with resection of the periampullary segment of the duodenum and resection of the intrapancreatic CBD.
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Maleux G, Bielen J, Laenen A, Heye S, Vaninbroukx J, Laleman W, Verhamme P, Wilmer A, Van Steenbergen W. Embolization of post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy: technical results, clinical efficacy and predictors of outcome. Eur Radiol 2014; 24:2779-86. [PMID: 25063394 DOI: 10.1007/s00330-014-3332-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 06/25/2014] [Accepted: 07/08/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE To retrospectively analyse the technical and clinical outcomes of embolotherapy for post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy, and in addition, to analyse factors potentially influencing 30-day mortality. MATERIALS AND METHODS From November 1998 to November 2012, 34 patients underwent percutaneous embolotherapy for post-biliary sphincterotomy bleeding refractory to medical and endoscopic treatment. Demographic, laboratory, angiographic, and clinical follow-up data were collected. RESULTS Indication for initial endoscopic sphincterotomy was benign (n = 28) or malignant (n = 6) disease. A precut sphincterotomy followed by sphincterotomy was performed in 13 patients (38 %), whereas the remaining 21 patients (62 %), underwent only sphincterotomy. Seven patients (20.6 %) were still on antithrombotic medication at the time of sphincterotomy. Angiographic evaluation revealed contrast extravasation (n = 31), pseudoaneurysm (n = 2), or a combination of both (n = 1). Embolization was successful in 33 of 34 patients (97 %). Recurrent bleeding occurred in three patients (9 %), and 30-day mortality was 20.6 % (n = 7). Factors significantly influencing 30-day mortality were INR (P = 0.008) and aPTT (P = 0.012). CONCLUSION Angiographic embolization is very effective in stopping post-biliary sphincterotomy bleeding refractory to medical and endoscopic therapy. The rate of rebleeding is acceptably low, but 30-day mortality remains significant. Haemostatic disorders appear to significantly influence 30-day survival. KEY POINTS • Transcatheter embolization is very effective in stopping major post-biliary sphincterotomy bleeding • The rate of rebleeding is acceptably low • Haemostatic disorders appear to significantly influence 30-day survival.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium,
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[Duodenum-preserving total pancreatic head resection : an organ-sparing operation technique for cystic neoplasms and non-invasive malignant tumors]. Chirurg 2014; 84:412-20. [PMID: 23417612 DOI: 10.1007/s00104-012-2423-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cystic neoplasms of the pancreas are being detected and surgically treated increasingly more frequently. Intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN) are primary benign lesions; however, the 5-year risk for malignant transformation has been estimated to be 63 % and 15 %, respectively. Surgical extirpation of a benign cystic tumor of the pancreas is a cancer preventive measure. The duodenum-preserving total pancreatic head resection technique (DPPHRt) is being used more frequently for cystic neoplasms of the pancreatic head. The complete resection of the pancreatic head can be applied as a duodenum-preserving technique or with segmental resection of the peripapillary duodenum. Borderline lesions, carcinoma in situ or T1N0 cancer of the papilla and the peripapillary common bile duct are also considered to be indications for segmental resection of the peripapillary duodenum. A literature search for cystic neoplastic lesions and DPPHRt revealed the most frequent indications to be IPMN, MCN and SCA lesions and 28 % suffered from a cystic neoplasm with carcinoma in situ or a peripapillary malignoma. The hospital mortality rate was 0.52 %. Compared to the Whipple type resection the DPPHRt exhibits significant benefits with respect to a low risk for early postoperative complications and a low hospital mortality rate of < 1 %. Exocrine and endocrine pancreatic functions after DPPHR are not impaired compared to the Whipple type resection.
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Beger HG, Schwarz M, Poch B. Duodenum-preserving total pancreatic head resection for benign cystic neoplastic lesions. J Gastrointest Surg 2012; 16:2160-6. [PMID: 22790582 DOI: 10.1007/s11605-012-1929-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 05/30/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cystic neoplasms of the pancreas are diagnosed frequently due to early use of abdominal imaging techniques. Intraductal papillary mucinous neoplasm, mucinous cystic neoplasm, and serous pseudopapillary neoplasia are considered pre-cancerous lesions because of frequent transformation to cancer. Complete surgical resection of the benign lesion is a pancreatic cancer preventive treatment. OBJECTIVES The application for a limited surgical resection for the benign lesions is increasingly used to reduce the surgical trauma with a short- and long-term benefit compared to major surgical procedures. Duodenum-preserving total pancreatic head resection introduced for inflammatory tumors in the pancreatic head transfers to the patient with a benign cystic lesion located in the pancreatic head, the advantages of a minimalized surgical treatment. PATIENTS Based on the experience of 17 patients treated for cystic neoplastic lesions with duodenum-preserving total pancreatic head resection, the surgical technique of total pancreatic head resection for adenoma, borderline tumors, and carcinoma in situ of cystic neoplasm is presented. A segmental resection of the peripapillary duodenum is recommended in case of suspected tissue ischemia of the peripapillary duodenum. In 305 patients, collected from the literature by PubMed search, in about 40% of the patients a segmental resection of the duodenum and 60% a duodenum and common bile duct-preserving total pancreatic head resection has been performed. RESULTS Hospital mortality of the 17 patients was 0%. In 305 patients collected, the hospital mortality was 0.65%, 13.2% experienced a delay of gastric emptying and a pancreatic fistula in 18.2%. Recurrence of the disease was 1.5%. Thirty-two of 175 patients had carcinoma in situ. CONCLUSION Duodenum-preserving total pancreatic head resection for benign cystic neoplastic lesions is a safe surgical procedure with low post-operative morbidity and mortality.
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So YH, Choi YH, Chung JW, Jae HJ, Song SY, Park JH. Selective embolization for post-endoscopic sphincterotomy bleeding: technical aspects and clinical efficacy. Korean J Radiol 2011; 13:73-81. [PMID: 22247639 PMCID: PMC3253406 DOI: 10.3348/kjr.2012.13.1.73] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 11/10/2011] [Indexed: 02/06/2023] Open
Abstract
Objective The objective of this study was to evaluate the technical aspects and clinical efficacy of selective embolization for post-endoscopic sphincterotomy bleeding. Materials and Methods We reviewed the records of 10 patients (3%; M:F = 6:4; mean age, 63.3 years) that underwent selective embolization for post-endoscopic sphincterotomy bleeding among 344 patients who received arteriography for nonvariceal upper gastrointestinal bleeding from 2000 to 2009. We analyzed the endoscopic procedure, onset of bleeding, underlying clinical condition, angiographic findings, interventional procedure, and outcomes in these patients. Results Among the 12 bleeding branches, primary success of hemostasis was achieved in 10 bleeding branches (83%). Secondary success occurred in two additional bleeding branches (100%) after repeated embolization. In 10 patients, post-endoscopic sphincterotomy bleedings were detected during the endoscopic procedure (n = 2, 20%) or later (n = 8, 80%), and the delay was from one to eight days (mean, 2.9 days; ± 2.3). Coagulopathy was observed in three patients. Eight patients had a single bleeding branch, whereas two patients had two branches. On the selective arteriography, bleeding branches originated from the posterior pancreaticoduodenal artery (n = 8, 67%) and anterior pancreaticoduodenal artery (n = 4, 33%), respectively. Superselection was achieved in four branches and the embolization was performed with n-butyl cyanoacrylate. The eight branches were embolized by combined use of coil, n-butyl cyanoacrylate, or Gelfoam. After the last embolization, there was no rebleeding or complication related to embolization. Conclusion Selective embolization is technically feasible and an effective procedure for post-endoscopic sphincterotomy bleeding. In addition, the posterior pancreaticoduodenal artery is the main origin of the causative vessels of post-endoscopic sphincterotomy bleeding.
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Affiliation(s)
- Young Ho So
- Department of Radiology, Seoul National University Boramae Medical Center, Seoul 156-707, Korea
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Horiguchi A, Ishihara S, Ito M, Nagata H, Asano Y, Yamamoto T, Kato R, Katada K, Miyakawa S. Multislice CT study of pancreatic head arterial dominance. ACTA ACUST UNITED AC 2008; 15:322-6. [DOI: 10.1007/s00534-007-1261-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 08/13/2007] [Indexed: 12/29/2022]
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