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Xia N, Li J, Wang Q, Huang X, Wang Z, Wang L, Tian B, Xiong J. Safety and effectiveness of minimally invasive central pancreatectomy versus open central pancreatectomy: a systematic review and meta-analysis. Surg Endosc 2024; 38:3531-3546. [PMID: 38816619 DOI: 10.1007/s00464-024-10900-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/02/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Central pancreatectomy is a surgical procedure for benign and low-grade malignant tumors which located in the neck and proximal body of the pancreas that facilitates the preservation of pancreatic endocrine and exocrine functions but has a high morbidity rate, especially postoperative pancreatic fistula (POPF). The aim of this systematic review and meta-analysis was to evaluate the safety and effectiveness between minimally invasive central pancreatectomy (MICP) and open central pancreatectomy (OCP) basing on perioperative outcomes. METHODS An extensive literature search to compare MICP and OCP was conducted from October 2003 to October 2023 on PubMed, Medline, Embase, Web of Science, and the Cochrane Library. Fixed-effect models or random effects were selected based on heterogeneity, and pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated. RESULTS A total of 10 studies with a total of 510 patients were included. There was no significant difference in POPF between MICP and OCP (OR = 0.95; 95% CI [0.64, 1.43]; P = 0.82), whereas intraoperative blood loss (MD = - 125.13; 95% CI [- 194.77, -55.49]; P < 0.001) and length of hospital stay (MD = - 2.86; 95% CI [- 5.00, - 0.72]; P = 0.009) were in favor of MICP compared to OCP, and there was a strong trend toward a lower intraoperative transfusion rate in MICP than in OCP (MD = 0.34; 95% CI [0.11, 1.00]; P = 0.05). There was no significant difference in other outcomes between the two groups. CONCLUSION MICP was as safe and effective as OCP and had less intraoperative blood loss and a shorter length of hospital stay. However, further studies are needed to confirm the results.
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Affiliation(s)
- Ning Xia
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Jiao Li
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of Nursing, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
- Disaster Medical Center, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Qiang Wang
- The People's Hospital of Jian Yang City, Jian yang, China
| | - Xing Huang
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Zihe Wang
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Li Wang
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Bole Tian
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
| | - Junjie Xiong
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
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Wei J, Ou Y, Chen J, Yu Z, Wang Z, Wang K, Yang D, Gao Y, Liu Y, Liu J, Zheng X. Mapping global new-onset, worsening, and resolution of diabetes following partial pancreatectomy: a systematic review and meta-analysis. Int J Surg 2024; 110:1770-1780. [PMID: 38126341 PMCID: PMC10942179 DOI: 10.1097/js9.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND AIMS Partial pancreatectomy, commonly used for chronic pancreatitis, or pancreatic lesions, has diverse impacts on endocrine and metabolism system. The study aims to determine the global prevalence of new-onset, worsening, and resolution of diabetes following partial pancreatectomy. METHODS The authors searched PubMed, Embase, Web of Science, and Cochrane Library from inception to October, 2023. DerSimonian-Laird random-effects model with Logit transformation was used. Sensitivity analysis, meta-regression, and subgroup analysis were employed to investigate determinants of the prevalence of new-onset diabetes. RESULTS A total of 82 studies involving 13 257 patients were included. The overall prevalence of new-onset diabetes after partial pancreatectomy was 17.1%. Univariate meta-regression indicated that study size was the cause of heterogeneity. Multivariable analysis suggested that income of country or area had the highest predictor importance (49.7%). For subgroup analysis, the prevalence of new-onset diabetes varied from 7.6% (France, 95% CI: 4.3-13.0) to 38.0% (UK, 95% CI: 28.2-48.8, P <0.01) across different countries. Patients with surgical indications for chronic pancreatitis exhibited a higher prevalence (30.7%, 95% CI: 21.8-41.3) than those with pancreatic lesions (16.4%, 95% CI: 14.3-18.7, P <0.01). The type of surgical procedure also influenced the prevalence, with distal pancreatectomy having the highest prevalence (23.7%, 95% CI: 22.2-25.3, P <0.01). Moreover, the prevalence of worsening and resolution of preoperative diabetes was 41.1 and 25.8%, respectively. CONCLUSIONS Postoperative diabetes has a relatively high prevalence in patients undergoing partial pancreatectomy, which calls for attention and dedicated action from primary care physicians, specialists, and health policy makers alike.
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Affiliation(s)
- Junlun Wei
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research
| | - Yiran Ou
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research
| | - Jiaoting Chen
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research
| | - Zhicheng Yu
- Department of Economics, Keio University, Minato city, Tokyo, Japan
| | - Zhenghao Wang
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research
| | - Ke Wang
- Department of Vascular Surgery, University Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Dujiang Yang
- Department of General Surgery, Division of Pancreatic Surgery, West China Hospital, Sichuan University
| | - Yun Gao
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research
| | - Yong Liu
- Department of General Surgery, Division of Pancreatic Surgery, West China Hospital, Sichuan University
| | - Jiaye Liu
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-Related Molecular Network, Center of Precision Medicine, Precision Medicine Key Laboratory of Sichuan Province
- Laboratory of Thyroid and Parathyroid diseases, Frontiers Science Center for Disease-Related Molecular Network
- Department of General Surgery, Division of Thyroid Surgery, West China Hospital, Sichuan University
| | - Xiaofeng Zheng
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research
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Terai T, Kawai M, Kitahata Y, Satoi S, Hashimoto D, Nagai M, Nishiwada S, Yamamoto T, Yamaue H, Sho M. Central pancreatectomy might be an acceptable surgical procedure for clinical T1 pancreatic body ductal adenocarcinoma: A multicenter retrospective analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:1334-1342. [PMID: 37792641 DOI: 10.1002/jhbp.1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Central pancreatectomy (CP) is accepted as a function-preserving procedure for benign tumors. However, the indication of CP for pancreatic cancers is limited. This multicenter study aimed to clarify the indications of CP for clinical T1 pancreatic body cancer. METHODS This multicenter study analyzed patients who underwent CP or distal pancreatectomy (DP) for clinical T1 pancreatic body cancer between 2013 and 2020 at three high-volume centers. RESULTS A total of 50 patients were enrolled: nine patients, who underwent CP, were classified into the CP group, while 38 patients, who underwent DP, served as controls. Three patients converted CP to DP during operation were excluded. Five patients in the CP group and 15 patients in the control group underwent preoperative treatment. The 5-year survival rate was 100% in the CP group, and 42% (p = .040) in the control group. Recurrence was found in three patients in the CP group. Importantly, insulin was not required after surgery in patients in the CP group. CONCLUSION The clinical outcomes of CP were comparable to or even better than that of conventional pancreatectomy. Our collaborative study suggests that CP may be an acceptable therapeutic option for selected patients with clinical T1 pancreatic body cancer.
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Affiliation(s)
- Taichi Terai
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Manabu Kawai
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yuji Kitahata
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Sohei Satoi
- Department of Surgery, Kansai Medical University, Hirakata City, Osaka, Japan
- Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daisuke Hashimoto
- Department of Surgery, Kansai Medical University, Hirakata City, Osaka, Japan
| | - Minako Nagai
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Satoshi Nishiwada
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Tomohisa Yamamoto
- Department of Surgery, Kansai Medical University, Hirakata City, Osaka, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
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Jung D, Bari H, Hwang HK, Lee WJ, Kang CM. Short and long-term outcomes of minimally invasive central pancreatectomy: Comparison with minimally invasive spleen-preserving subtotal distal pancreatectomy. Asian J Surg 2023; 46:824-828. [PMID: 36089433 DOI: 10.1016/j.asjsur.2022.08.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Central pancreatectomy(CP) is more complex surgery and higher complication rate than distal pancreatectomy(DP). However, with the development of minimally invasive surgery, CP has become a safer surgery technique. In this study, we compare minimally invasive CP(MI-CP) and Minimally invasive spleen-preserving subtotal DP(MI-SpSTDP) to figure out the short-term and long-term outcomes of MI-CP. METHODS From March 2007 to June 2020, 36 cases of MI-SpSTDP and 23 cases of MI-CP were performed for benign and borderline malignant pancreatic tumors in Severance hospital. The occurrence of postoperative pancreatic fistula(POPF) and Clavian-Dindo classification grade 3 or more in the two group was investigated, and the Controlling nutritional status scores(CONUT score) before and 1-year after surgery were compared to determine the long-term outcomes of exocrine function. RESULTS There was no difference in postoperative complications including POPF between the two groups(17.4% vs 5.1%, p = 0.294). And there were no statistical differences in either the MI-CP group (0.74 ± 0.75 vs. 0.78 ± 0.99, p = 0.803) or the MI-SpSTDP group (0.86 ± 0.83 to 0.61 ± 0.59, p = 0.071). CONCLUSIONS MI-CP had longer operation time and hospital stay and is safe and effective in preserving endocrine and exocrine functions in treatment of benign or borderline tumors located at the neck or proximal body of the pancreas.
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Affiliation(s)
- Dawn Jung
- Division of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, South Korea; Pancreatobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea
| | | | - Ho Kyoung Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, South Korea; Pancreatobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea
| | - Woo Jung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, South Korea; Pancreatobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea
| | - Chang Moo Kang
- Division of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, South Korea; Pancreatobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea.
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5
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Klotz R, Schilling C, Kuner C, Hinz U, Klaiber U, Holze M, Tjaden C, Loos M, Büchler MW, Hackert T. Central pancreatectomy prevents postoperative diabetes. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022. [PMID: 36457298 DOI: 10.1002/jhbp.1296] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/17/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Central pancreatectomy (CP) can be performed as an alternative surgical approach to distal pancreatectomy (DP) in the treatment of benign or low-grade malignant lesions located in the neck and body of the pancreas, aiming to reduce loss of parenchyma and therefore organ failure. The objective of this study was to evaluate the short- and long-term outcome of CP in comparison to DP. METHODS Patients who received CP in a large tertiary care pancreatic surgery center between 2001 and 2020 were identified from a prospectively maintained database and compared via propensity score matching with patients receiving DP during the same time period. Perioperative rate of complications and long-term outcome of pancreatic endocrine and exocrine function were evaluated. RESULTS One hundred and seven patients undergoing open CP were compared to 107 patients with open DP. No significant difference in rates or severity of most surgical complications could be found including postoperative pancreatic fistula, intraabdominal fluid collection, delayed gastric emptying and wound infection. However, patients receiving CP had a significantly higher risk of grade C postpancreatectomy hemorrhage (PPH) (CP: 10 patients, 9.3% versus DP: 1 patient, 0.9%; p = .0019). Perioperative mortality was comparable. Long-term follow-up of 60 matched pairs revealed significantly less patients with new-onset diabetes after CP (eight patients, 13.3%) compared to DP (22 patients, 36.7%, p = .0056). CONCLUSION CP offers an improved endocrine long-term outcome at the expense of a higher risk of PPH without increased perioperative mortality. As evidence on this parenchyma sparing surgical technique is sparse, more prospective data are needed.
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Affiliation(s)
- Rosa Klotz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.,Study Center of the German Society of Surgery, Heidelberg, Germany
| | - Constanze Schilling
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Charlotte Kuner
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulf Hinz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulla Klaiber
- Department of General Surgery, Division of Visceral Surgery, University Hospital Vienna, Vienna, Austria
| | - Magdalena Holze
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.,Study Center of the German Society of Surgery, Heidelberg, Germany
| | - Christine Tjaden
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Loos
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Chen YW, Xu J, Li X, Chen W, Gao SL, Shen Y, Zhang M, Wu J, Que RS, Yu J, Liang TB, Bai XL. Central pancreatectomy for benign or low-grade malignant pancreatic tumors in the neck and body of the pancreas. World J Gastrointest Surg 2022; 14:896-903. [PMID: 36185570 PMCID: PMC9521472 DOI: 10.4240/wjgs.v14.i9.896] [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: 03/15/2022] [Revised: 05/12/2022] [Accepted: 08/16/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND For tumors in the neck and body of the pancreas, distal pancreatectomy (DP) has been the standard surgical procedure for the last few decades and central pancreatectomy (CP) is an alternative surgical option. Whether CP better preserves remnant pancreatic endocrine and exocrine functions after surgery remains a subject of debate.
AIM To evaluate the safety and efficacy of CP compared with DP for benign or low-grade malignant pancreatic tumors in the neck and body of the pancreas.
METHODS This retrospective study enrolled 296 patients who underwent CP or DP for benign and low-malignant neoplasms at the same hospital between January 2016 and March 2020. Perioperative outcomes and long-term morbidity of endocrine/exocrine function were prospectively evaluated.
RESULTS No significant difference was observed in overall morbidity or clinically relevant postoperative pancreatic fistula between the two groups (P = 0.055). Delayed gastric emptying occurred more frequently in the CP group than in the DP group (29.4% vs 15.3%; P < 0.005). None of the patients in the CP group had new-onset or aggravated distal metastasis, whereas 40 patients in the DP group had endocrine function deficiency after surgery (P < 0.05). There was no significant difference in the incidence of diarrhea immediately after surgery, but at postoperative 12 mo, a significantly higher number of patients had diarrhea in the DP group than in the CP group (0% vs 9.5%; P < 0.05).
CONCLUSION CP is a generally safe procedure and is better than DP in preserving long-term pancreatic endocrine and exocrine functions. Therefore, CP might be a better option for treating benign or low-grade malignant neoplasms in suitable patients.
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Affiliation(s)
- Yi-Wen Chen
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Jian Xu
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Xiang Li
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Wei Chen
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Shun-Liang Gao
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Yan Shen
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Min Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Jian Wu
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Ri-Sheng Que
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Jun Yu
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Ting-Bo Liang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
- Department of Pancreatic Disease, Zhejiang Provincial Key Laboratory, Hangzhou 310000, Zhejiang Province, China
- The Study of Pancreatic Disease, Zhejiang Provincial Innovation Center, Hangzhou 310000, Zhejiang Province, China
- The Study of Hepatobiliary & Pancreatic Diseases, Zhejiang Provincial Clinical Research Center, Hangzhou 310003, Zhejiang Province, China
- Cancer Center, Zhejiang University, Hangzhou 310058, Zhejiang Province, China
| | - Xue-Li Bai
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
- Department of Pancreatic Disease, Zhejiang Provincial Key Laboratory, Hangzhou 310000, Zhejiang Province, China
- The Study of Pancreatic Disease, Zhejiang Provincial Innovation Center, Hangzhou 310000, Zhejiang Province, China
- The Study of Hepatobiliary & Pancreatic Diseases, Zhejiang Provincial Clinical Research Center, Hangzhou 310003, Zhejiang Province, China
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Fujita Y, Hirono S, Kawai M, Okada KI, Miyazawa M, Kitahata Y, Ueno M, Hayami S, Kobayashi R, Yanagisawa A, Yamaue H. Malignant potential and specific characteristics of pure main duct type intraductal papillary mucinous neoplasm. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1054-1061. [PMID: 34933794 DOI: 10.1016/j.ejso.2021.11.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/03/2021] [Accepted: 11/29/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND As the malignant potential of main duct (MD-) type intraductal papillary mucinous neoplasm (IPMN) has been discussed together with Mixed-type in most previous studies, the malignant potential of pure MD-type IPMN remains unclear. This study evaluated the specific characteristics and predictors of high-grade dysplasia (HGD) and invasive intraductal papillary mucinous carcinoma (IPMC) for pure MD-type IPMN. METHODS From 1,100 patients with IPMN, this study includes 387 patients that underwent surgery. We evaluated the specific characteristics of pure MD-type IPMN by comparing clinicopathological factors between MD-type (n = 79) and branch duct (BD-) type (n = 146) or Mixed-type IPMN (n = 162), and predictors of HGD/invasive IPMC in pure MD-type IPMN. RESULTS The rate of HGD/invasive IPMC was significantly higher in MD-type than in BD-type (70.9 vs. 48.6%, P = 0.001), although there was no difference between MD-type and Mixed-type IPMNs (P = 0.343). Recurrence-free survival (RFS) and disease-specific survival (DSS) of patients with MD-type were better than those of patients with Mixed-type (P = 0.008 and P = 0.009, respectively). There were no significant differences in RFS, overall survival, and DSS between patients with MD-type and patients with BD-type IPMNs. Multivariate analysis showed two independent predictors of HGD/invasive IPMC in MD-type IPMN; mural nodule height ≥5 mm (P = 0.025, odds ratio [OR]; 16.949) and carcinoembryonic antigen (CEA) level in the pancreatic juice obtained by preoperative endoscopic retrograde pancreatography ≥50 ng/ml (P = 0.039, OR; 9.091). CONCLUSIONS Measurement of mural nodule height and CEA in the pancreatic juice might be useful in determining surgical indication for pure MD-type IPMN, although further studies for confirmation are essential.
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Affiliation(s)
- Yoichi Fujita
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Japan
| | - Seiko Hirono
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Japan.
| | - Manabu Kawai
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Japan
| | - Ken-Ichi Okada
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Japan
| | - Motoki Miyazawa
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Japan
| | - Yuji Kitahata
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Japan
| | - Masaki Ueno
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Japan
| | - Shinya Hayami
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Japan
| | - Ryohei Kobayashi
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Japan
| | - Akio Yanagisawa
- Department of Pathology, Japanese Red Cross Kyoto Daiichi Hospital, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Japan
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Beger HG, Mayer B, Vasilescu C, Poch B. Long-term Metabolic Morbidity and Steatohepatosis Following Standard Pancreatic Resections and Parenchyma-sparing, Local Extirpations for Benign Tumor: A Systematic Review and Meta-analysis. Ann Surg 2022; 275:54-66. [PMID: 33630451 DOI: 10.1097/sla.0000000000004757] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess metabolic dysfunctions and steatohepatosis after standard and local pancreatic resections for benign and premalignant neoplasms. SUMMARY OF BACKGROUND DATA Duodenopancreatectomy, hemipancreatectomy, and parenchyma-sparing, limited pancreatic resections are currently in use for nonmalignant tumors. METHODS Medline, Embase, and Cochrane libraries were searched for studies reporting measured data of metabolic functions following PD, pancreatic left resection (PLR), duodenum-sparing pancreatic head resection (DPPHR), pancreatic middle segment resection (PMSR), and tumor enucleation (TEN). Forty cohort studies comprising data of 2729 patients were eligible. RESULTS PD for benign tumor was associated in 46 of 327 patients (14.1%) with postoperative new onset of diabetes mellitus (pNODM) and in 109 of 243 patients (44.9%) with postoperative new onset of pancreatic exocrine insufficiency measured after a mean follow-up of 32 months. The meta-analysis displayed pNODM following PD in 32 of 204 patients (15.7%) and in 10 of 200 patients (5%) after DPPHR [P < 0.01; OR: 0.33; (95%-CI: 0.15-0.22)]. PEI was found in 77 of 174 patients following PD (44.3%) and in 7 of 104 patients (6.7%) following DPPHR (P < 0.01;OR: 0.15; 95%-CI: 0.07-0.32). pNODM following PLR was reported in 107 of 459 patients (23.3%) and following PMSR 23 of 412 patients (5.6%) (P < 0.01; OR: 0.20; 95%-CI: 0.12-0.32). Postoperative new onset of pancreatic exocrine insufficiency was found in 17% following PLR and in 8% following PMSR (P < 0.01). pNODM following PPPD and tumor enucleation was observed in 19.7% and 5.7% (P < 0.03) of patients, respectively. Following PD/PPPD, 145 of 608 patients (23.8%) developed a nonalcoholic fatty liver disease after a mean follow-up of 30.4 months. Steatohepatosis following DPPHR developed in 2 of 66 (3%) significantly lower than following PPPD (P < 0.01). CONCLUSION Standard pancreatic resections for benign tumor carry a considerable high risk for a new onset of diabetes, pancreatic exocrine insufficiency and following PD for steatohepatosis. Parenchyma-sparing, local resections are associated with low grade metabolic dysfunctions.
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Affiliation(s)
- Hans G Beger
- c/o University of Ulm, 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
| | - Catalin Vasilescu
- Fundeni Clinical Institute; Department of General Surgery, Bucharest, Romania
| | - Bertram Poch
- Center for Oncologic, Endocrine and Minimal Invasive Surgery, Donau-Klinikum, Neu-Ulm, Germany
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9
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P SK, Harikrishnan S, Satyanesan J. Central Pancreatectomy for Central Pancreatic Lesions: A Single-Institution Experience. Cureus 2021; 13:e16108. [PMID: 34350075 PMCID: PMC8325928 DOI: 10.7759/cureus.16108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 01/02/2023] Open
Abstract
Background Pancreaticoduodenectomy and distal pancreatectomy are radical procedures for pancreatic lesions with high postoperative morbidity and mortality even in experienced hands. Central pancreatectomy is an alternative less radical procedure for centrally located pancreatic lesions that are benign or have a low malignant potential. It involves removing the central portion of the pancreas and has the advantage of preserving the pancreatic parenchyma, thereby decreasing the postoperative endocrine and exocrine insufficiencies. Methods We conducted a prospective study of six cases of central pancreatectomy in the Department of Surgical Gastroenterology and Liver Transplant, Government Stanley Medical College, India, between the years 2015 and 2019. All patients with lesions in the neck and proximal body of the pancreas were clinically and radiologically evaluated, and those with benign or borderline malignant lesions underwent central pancreatectomy by a standardized technique. Results The mean age of the patients was 27.8 years (range: 14 years - 37 years). Most of the patients were females (66.6%). The most common presenting symptom was abdominal pain, and the most common diagnosis was solid pseudopapillary neoplasm (83.3%). The mean diameter of the lesion was 6.1 cm. All patients underwent pancreaticojejunostomy of the distal stump. The median operative time and the blood loss were 310 minutes and 85 ml, respectively. Two patients developed biochemical postoperative pancreatic fistula, and in the long-term follow-up, none of them developed endocrine or exocrine insufficiency. Conclusion Central pancreatectomy is a safe and effective alternative for benign and low-grade lesions in the neck and body of the pancreas in which the head of the pancreas and a significant portion of the distal body and tail of the pancreas is uninvolved. Standardization of this pancreas-preserving procedure will result in better outcomes.
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Affiliation(s)
- Senthil Kumar P
- Surgical Gastroenterology and Liver Transplant, Government Stanley Medical College, Chennai, IND
| | - Sakthivel Harikrishnan
- Surgical Gastroenterology and Liver Transplant, Government Stanley Medical College, Chennai, IND
| | - Jeswanth Satyanesan
- Surgical Gastroenterology and Liver Transplant, Government Stanley Medical College, Chennai, IND
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10
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Division of the pancreas at the neck reduces postoperative pancreatic fistula in laparoscopic distal pancreatectomy: Comparison of pancreatic division at the body. Pancreatology 2021; 21:480-486. [PMID: 33518455 DOI: 10.1016/j.pan.2020.12.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/24/2020] [Accepted: 12/27/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND objectives: During laparoscopic distal pancreatectomy (LDP), the optimal site for pancreatic division with consideration of postoperative pancreatic fistula (POPF) is unclear. We evaluate which site of pancreatic division, neck or body, has better outcomes after LDP. METHODS This was a retrospective, observational study. LDP was performed in 102 consecutive patients between December 2009 and May 2020. After excluding 14 patients with pancreatic division at tail, 88 patients (pancreatic division at neck n = 46, at body n = 42) were included in this study. Short- and long-term outcomes after LDP were compared between pancreatic division at neck and body. RESULTS The pancreatic transection site was thicker at body than at neck (17.5 vs. 11.9 mm, P < 0.001), although there were no significant differences of pancreatic texture and pancreatic duct size. The Grade B/C POPF rate was significantly higher when the pancreas was divided at body than when divided at neck (21.4 vs. 6.5%, P = 0.042). We found no significant differences between pancreatic division at neck and body in residual pancreatic volume (34.0 vs. 34.8 ml, P = 0.855), incidence of new-onset or worsening diabetes mellitus more than six months after LDP (P = 0.218), or body weight change (six-month: P = 0.116, one-year: P = 0.108, two-year: P = 0.195, tree-year: P = 0.131, four-year: P = 0.608, five-year: P = 0.408). CONCLUSION This study suggests that the pancreatic division at neck might reduce the Grade B/C POPF incidence after LDP, compared to division at body. A potential reason is that the pancreas at body is thicker than that at neck. However, further large-scale studies are necessary to confirm our results.
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11
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Moureletou RP, Kalliouris D, Manesis K, Theodoroleas S, Bistaraki A, Boubousis G, Nikou E. Central Pancreatectomy with Roux-en-Y Pancreaticojejunal Anastomosis-Report of Two Cases. Surg J (N Y) 2020; 6:e175-e179. [PMID: 33335985 PMCID: PMC7735870 DOI: 10.1055/s-0040-1718699] [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: 11/30/2019] [Accepted: 05/19/2020] [Indexed: 10/28/2022] Open
Abstract
Background Central pancreatectomy (CP), a partial resection of the pancreas, is indicated for the excision of neuroendocrine tumors (NETs) of the pancreas, when located at the neck or the proximal body. Specifically, CP is preferable in functional NET and in nonfunctional sized 1 to 2 cm or/with proliferation marker Ki67 < 20% (Grade I/II). Postoperative leakage from the remaining pancreas constitutes the most frequent complication of CP (up to 63%). The aim of our study was to share the experience of our center in CP for NET, with pancreaticojejunal anastomosis. Methods In 1 year, we performed CP in two patients, following the aforementioned criteria. They presented with tumor of the body of the pancreas, which was found in random check with computed tomography, with negative hormonal blood tests and they underwent magnetic resonance imaging and endoscopic ultrasound/fine-needle biopsy/pathological examination. Results The patients underwent CP with Roux-en-Y pancreaticojejunal anastomosis of the distal pancreatic stump and jejunal patch of the proximal pancreatic stump. Histological exam revealed NET sized 2.8 cm and 1.45 cm, Grade I and II, respectively. Postoperatively both patients developed small pancreatic leakage, which did not affect their physical condition and stopped after 20 and 30 days. No one needed pancreatic enzymes supplements or developed new-onset diabetes mellitus. Conclusion CP provided adequate, functional remaining pancreatic tissue in both patients. Small leakages were treated conservatively and retreated without septic complications. As a result, CP might be considered as safe and effective technique for pancreatic neck/proximal body NET.
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Affiliation(s)
| | | | | | | | | | - George Boubousis
- 2nd Department of General Surgery, 417 Army Share Fund Hospital, Athens, Greece
| | - Efstathios Nikou
- 2nd Department of General Surgery, 417 Army Share Fund Hospital, Athens, Greece
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12
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Zhang RC, Ma J, Mou YP, Zhou YC, Jin WW, Lu C. Short- and Long-Term Outcomes of Laparoscopic Organ-Sparing Resection for Pancreatic Neuroendocrine Neoplasms. World J Surg 2020; 44:3795-3800. [PMID: 32700111 DOI: 10.1007/s00268-020-05707-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pancreatic neuroendocrine neoplasms (PNENs) are rare neoplasms associated with a long life expectancy after resection. In this setting, patients may benefit from laparoscopic organ-sparing resection. Studies of laparoscopic organ-sparing resection for PNENs are limited. The aim of this study was to evaluate the short- and long-term outcomes of laparoscopic organ-sparing resection for PNENs. METHODS A retrospective study was performed for patients with PNENs who underwent laparoscopic organ-sparing pancreatectomy between March 2005 and May 2018. The patients' demographic data, operative results, pathological reports, hospital courses and morbidity, mortality, and follow-up data (until August 2018) were analysed. RESULTS Thirty-five patients were included in the final analysis. There were 9 male and 26 female patients, with a median age of 46 years (range 25-75 years). The mean BMI was 24.6 ± 3.3 kg/m2. Nine patients received laparoscopic enucleation (LE), 20 received laparoscopic spleen-preserving distal pancreatectomy (LSPDP), and 6 received laparoscopic central pancreatectomy. The operative time, intraoperative blood loss, transfusion rate, and postoperative hospital stay were 186.4 ± 60.2 min, 165 ± 73.0 ml, 0 days, and 9 days (range 5-23 days), respectively. The morbidity rate, grade ≥ III complication rate, and grade ≥ B pancreatic fistula rate were 34.2%, 11.4%, and 8.7%, respectively, with no mortality. The rate of follow-up was 94.3%, and the median follow-up time was 55 months (range 3-158 months). One patient developed recurrence 36 months after LE and was managed with surgical resection. The other patients survived without metastases or recurrence during the follow-up. One patient had diabetes after LSPDP, and no patients had symptoms of pancreatic exocrine insufficiency. Nineteen patients who underwent LSPDP (16 with the Kimura technique and 3 with the Warshaw technique) were followed. Normal patency of the splenic artery and vein was observed in 14 and 14 patients within 1 month of surgery and in 15 and 14 patients 6 months or more after the operation, respectively. Partial splenic infarction was observed in 3 patients within 1 month of surgery and in no patients 6 months or more after the operation. Three patients eventually developed collateral venous vessels around the gastric fundus and reserved spleen, with one case of variceal bleeding. CONCLUSIONS Laparoscopic organ-sparing resection for selected cases of PNENs is safe and feasible and has favourable short- and long-term outcomes.
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Affiliation(s)
- Ren-Chao Zhang
- Department of Gastrointestinal & Pancreatic Surgery, Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China
| | - Jun Ma
- Department of Gastrointestinal & Pancreatic Surgery, Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China
| | - Yi-Ping Mou
- Department of Gastrointestinal & Pancreatic Surgery, Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China.
| | - Yu-Cheng Zhou
- Department of Gastrointestinal & Pancreatic Surgery, Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China
| | - Wei-Wei Jin
- Department of Gastrointestinal & Pancreatic Surgery, Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China
| | - Chao Lu
- Department of Gastrointestinal & Pancreatic Surgery, Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China
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13
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Zhang RC, Ma J, Mou YP, Yan JF, Zhou YC. Comparison of clinical outcomes and quality of life between laparoscopic distal pancreatectomy with or without spleen preservation. Surg Endosc 2020; 35:3412-3420. [PMID: 32632480 DOI: 10.1007/s00464-020-07783-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The studies comparing laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and laparoscopic distal pancreatosplenectomy (LDPS) are limited. This study aimed to compare clinical outcomes and quality of life of patients undergoing LSPDP and LDPS. METHODS Between March 2004 and December 2014, patients who underwent laparoscopic distal pancreatectomy were reviewed. Patients were divided into 2 groups as LSPDP and LDPS. Data considered for comparison analysis were patient demographics, intraoperative variables, morbidity, postoperative hospital stay, mortality, pathologic findings, and quality of life (SF-36 questionnaire). RESULTS A total of 110 patients (50 LSPDP and 60 LDPS) were included in the final analysis. Baseline characteristics were similar in the 2 groups. The LSPDP group had a significantly shorter operative time(153.3 ± 46.2 vs. 179.9 ± 54.1 min, p = 0.015) than the LDPS group. Also in analysis of propensity-matched population(LSPDP:LDPS = 35:35, 1:1 matching), LSPDP group still had a significantly shorter operative time (159.3 ± 36.2 vs. 172.9 ± 44.1 min, p = 0.045) than the LDPS group.There were no significant differences with respect to estimated blood loss, first flatus time, diet start time, and postoperative hospital stay. Postoperative outcomes, including morbidity, pancreatic fistula rates, and mortality, were similar in the LSPDP and LDPS group. On the follow-up survey, the total quality of life score (635.8 ± 50.7 vs. 596.1 ± 92.1)was higher in the LSPDP group compared with the LDPS group. However, the differences were not statistically significant(p > 0.05). The score in vitality (82.5 ± 14.4 vs. 68.9 ± 11.4, p = 0.046) was significantly higher in LSPDP group and not statistically significant in other areas (p > 0.05).Similar results of quality of life assessment were found in analysis of propensity-matched population. CONCLUSIONS Compared to LDPS, LSPDP had shorter operating time and better quality of life with similar morbidity and recovery period.
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Affiliation(s)
- Ren-Chao Zhang
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China
| | - Jun Ma
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China
| | - Yi-Ping Mou
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China.
| | - Jia-Fei Yan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang Province, China
| | - Yu-Cheng Zhou
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China
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14
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Tariq M, Jajja MR, Maxwell DW, Galindo RJ, Sweeney JF, Sarmiento JM. Diabetes development after distal pancreatectomy: results of a 10 year series. HPB (Oxford) 2020; 22:1034-1041. [PMID: 31718897 DOI: 10.1016/j.hpb.2019.10.2440] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 10/05/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Limited literature is available on the postoperative development of impaired glucose tolerance (IGT) and new-onset diabetes mellitus (NODM) following Distal Pancreatectomy (DP). We aimed to study the post-surgical clinical evolution of IGT/DM and its association with preoperative glycemic profiles of patients undergoing DP. METHODS Pre- and postoperative glycemic laboratories were measured in patients undergoing DP by the senior author from 2007-2017. Multivariate risk factor analysis was performed to determine risk factors for new-onset IGT/DM after DP. Kaplan-Meier curves were constructed for development of NODM postoperatively. RESULTS Of 216 included patients, n = 63, n = 68 and n = 85 were preoperatively diagnosed with no-diabetes (No-DM), pre-diabetes (Pre-DM), and diabetes (DM), respectively. At 2-year follow-up, n = 37, n = 80 and n = 99 were classified as No-DM, Pre-DM or DM, respectively. Pre-diabetics had a higher risk of developing postoperative dysglycemia (RR 2.230, 95% CI 1.732-2.870, p = 0.001). Preoperative OGTT>130, HbA1c >6.0, and chronic pancreatitis were risk factors for postoperative DM. CONCLUSION 40% of patients undergoing DP were unaware of their dysglycemic status (pre-DM or DM) pre-operatively. At 2-year follow-up, 36% non-diabetic and 57% pre-diabetic patients had developed NODM. Appropriate pre-operative diabetic assessment is warranted for all patients undergoing pancreatic resections.
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Affiliation(s)
- Marvi Tariq
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohammad R Jajja
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel W Maxwell
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Rodolfo J Galindo
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - John F Sweeney
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Juan M Sarmiento
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
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15
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Yu J, Sun R, Han X, Liu Z. New-Onset Diabetes Mellitus After Distal Pancreatectomy: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2020; 30:1215-1222. [PMID: 32559393 DOI: 10.1089/lap.2020.0090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background and Objective: Endocrine insufficiency must be considered following distal pancreatectomy (DP), because diabetes mellitus can impose a long-term burden on patients. This systematic review and meta-analysis aimed to identify the incidence and severity of new-onset diabetes mellitus (NODM) after DP for benign and malignant tumors, and other indications. Methods: Articles reporting NODM after DP from PubMed, Embase, Cochrane Library, and Google Scholar were analyzed. The quality of the studies was assessed using the Newcastle-Ottawa Scale or MOGA scale. Inverse variance analysis calculated the overall NODM incidence, and 95% confidence intervals (CIs) and P values were determined. Subgroup analyses considered pre-existing pancreatic diseases. Results: The quantitative analysis involved 18 articles that described 2356 patients with pancreatic neoplasms or inflammatory lesions. The overall incidence of NODM after DP was 29% (95% CI 25-33). The NODM rates were 23% (95% CI 17-30) and 38% (95% CI 30-45) for patients with pancreatic neoplasms and chronic pancreatitis, respectively. Pre-existing chronic pancreatitis and being male were risks associated with NODM. Conclusion: NODM is fairly common after DP. Surgeons and patients should be aware of postoperative treatment-dependent endocrine dysfunction. Larger cohort studies are required to clarify the risk factors for NODM after DP.
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Affiliation(s)
- Jiawen Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Sun
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Xianlin Han
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ziwen Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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16
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Wu L, Nahm CB, Jamieson NB, Samra J, Clifton-Bligh R, Mittal A, Tsang V. Risk factors for development of diabetes mellitus (Type 3c) after partial pancreatectomy: A systematic review. Clin Endocrinol (Oxf) 2020; 92:396-406. [PMID: 32017157 DOI: 10.1111/cen.14168] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/02/2020] [Accepted: 02/02/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Type 3c diabetes mellitus (T3cDM) occurring post pancreatectomy can be challenging to treat due to the frequent combination of decreased circulating levels of insulin and glucagon and concurrent exocrine insufficiency. Relatively, little is known regarding the risk factors for development of T3cDM post pancreatectomy. Our aim was to review the literature and assess what is known of the risk factors for the development of new-onset DM following partial pancreatic resection and where possible determines the incidence, time of onset and the management approach to hyperglycaemia in this context. DESIGN Medline and Embase databases were reviewed using specific keyword criteria. Original manuscripts published in 1990 or later included. Articles with study population <20, lacking information on new-onset DM, follow-up duration or specifically targeting rare procedures/pathology were excluded. The Newcastle Ottawa Quality Assessment form was applied. Results reported according to PRISMA guidelines. Pooled effect size calculated using random effects model. PATIENTS Thirty six articles were identified that described a total of 5636 patients undergoing pancreaticoduodenectomy, 3922 patients having distal pancreatectomy and 315 with central pancreatectomy. RESULTS The incidence of new-onset DM was significantly different between different types of resection from 9% to 24% after pancreaticoduodenectomy (pooled estimate 16%; 95% CI: 14%-17%), 3%-40% after distal pancreatectomy (pooled estimate 21%; 95% CI: 16%-25%) and 0%-14% after central pancreatectomy (pooled estimate 6%; 95% CI: 3%-9%). Surgical site, higher preoperative HbA1c, fasting plasma glucose and lower remnant pancreatic volume had strongest associations with new-onset DM. CONCLUSIONS This systematic review supports that risk of development of T3cDM is associated with type of pancreatic resection, lower remnant pancreatic volume and higher preoperative HbA1c.
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Affiliation(s)
- Linda Wu
- Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Christopher B Nahm
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, NSW, Australia
- Sydney Medical School Northern, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nigel B Jamieson
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jaswinder Samra
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, NSW, Australia
- Faculty of Medical and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Roderick Clifton-Bligh
- Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia
- Sydney Medical School Northern, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Anubhav Mittal
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, NSW, Australia
- Sydney Medical School Northern, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Venessa Tsang
- Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia
- Sydney Medical School Northern, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Overall Postoperative Morbidity and Pancreatic Fistula Are Relatively Higher after Central Pancreatectomy than Distal Pancreatic Resection: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7038907. [PMID: 32219139 PMCID: PMC7057026 DOI: 10.1155/2020/7038907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 02/05/2023]
Abstract
Objective To compare the intraoperative and postoperative outcomes of central pancreatectomy (CP) with distal pancreatectomy (DP). Methods A systematic literature search was performed on electronic databases from MEDLINE, Embase, and PubMed from 1998 to 2018. Statistical analysis and meta-analysis were performed using statistics/data analysis (Stata®) software, version 12.0 (StataCorp LP, College Station, Texas 77845, USA). Dichotomous variables were analyzed by estimation of relative risk (RR) with a 95 percent (%) confidence interval (CI) and continuous variables were analyzed by standardized mean differences (SMD) with 95% CI. Results Twenty-four studies with 593 CP and 1226 DP were included in the meta-analysis. CP had significantly longer operation time (SMD: 1.03; 95% CI 0.62 to 1.44; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.01). Estimated blood loss was significantly lower in CP (SMD: -0.34; 95% CI -0.58 to -0.09; P = 0.007). Overall postoperative morbidity (RR: 1.30; 95% CI: 1.13 to 1.50; P < 0.001), overall pancreatic fistula (RR: 1.41; 95% CI: 1.20 to 1.66; P < 0.001), clinically relevant fistula (RR: 1.64; 95% CI: 1.25 to 2.16; P < 0.001), and postoperative hemorrhage (RR: 1.90; 95% CI: 1.18 to 3.06; P < 0.05) were all significantly higher after CP. On long-term follow-up, DP patients were more likely to have postoperative exocrine (RR: 0.56; 95% CI: 0.37 to 0.84; P < 0.05) and endocrine (RR: 0.27; 95% CI: 0.18 to 0.40; P < 0.001) insufficiency. There was no statistically significant difference in transfusion requirement, postoperative mortality, reoperation, and tumor recurrence. Conclusion CP is associated with significantly higher morbidity and clinically relevant pancreatic fistula. CP should only be reserved for selected patients who require postoperative pancreatic function preservation.
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Shi Y, Jin J, Huo Z, Wang J, Weng Y, Zhao S, Deng X, Shen B, Peng C. An 8-year single-center study: 170 cases of middle pancreatectomy, including 110 cases of robot-assisted middle pancreatectomy. Surgery 2020; 167:436-441. [DOI: 10.1016/j.surg.2019.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 02/07/2023]
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19
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Lee DH, Jang JY. ASO Author Reflections: Central Pancreatectomy Versus Distal Pancreatectomy and Pancreaticoduodenectomy for Benign or Low-Grade Malignant Neoplasms: A Propensity Score-Matched Study with Long-Term Functional Outcomes and Pancreas Volumetry. Ann Surg Oncol 2020; 27:1225-1226. [PMID: 31965371 DOI: 10.1245/s10434-019-08133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Doo-Ho Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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20
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Lee DH, Han Y, Byun Y, Kim H, Kwon W, Jang JY. Central Pancreatectomy Versus Distal Pancreatectomy and Pancreaticoduodenectomy for Benign and Low-Grade Malignant Neoplasms: A Retrospective and Propensity Score-Matched Study with Long-Term Functional Outcomes and Pancreas Volumetry. Ann Surg Oncol 2020; 27:1215-1224. [PMID: 31898101 DOI: 10.1245/s10434-019-08095-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND It remains controversial whether central pancreatectomy (CP) can preserve the exocrine and endocrine function of the pancreas or not. This study aimed to evaluate the safety and efficacy of CP compared with distal pancreatectomy (DP) and pancreaticoduodenectomy (PD) for benign and low-grade malignant neoplasms. METHODS This retrospective study enrolled 219 patients who underwent elective CP (n = 55), DP (n = 70), or PD (n = 94) for benign and low-malignant neoplasms in a single university hospital between January 2000 and December 2015. Patients who underwent CP were propensity score matched to patients who underwent DP or PD at a 1:1 ratio, respectively. Peri- and postoperative outcomes, long-term endocrine/exocrine function, and pancreatic volume change 12 months postoperatively were prospectively evaluated. RESULTS Of the 165 patients, 55 were included in each of the CP, DP, and PD groups. Significant differences between the CP and DP groups were observed in overall morbidity (CP: n = 18, 33% vs DP: n = 8, 14%; P = 0.041), clinically relevant postoperative pancreatic fistula (CP: n = 13, 24% vs DP: n = 4, 7%; P = 0.022), stool elastase level 12 months after surgery (CP: 151 μg/g vs DP: 245 μg/g; P = 0.003), and percentage change in the remnant pancreatic volume 12 months after surgery (CP: - 9.4% vs DP: + 7.5%; P < 0.001). CONCLUSIONS The indications for CP to treat benign and low-grade malignant pancreatic neoplasms should be limited to cases in which the distal pancreatic volume can be considerably saved and PD can be prevented because CP has a higher postoperative morbidity without a marked functional superiority over DP.
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Affiliation(s)
- Doo-Ho Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.,Department of Surgery, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Youngmin Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Yoonhyeong Byun
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Hongbeom Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
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21
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Hirono S, Yamaue H. Surgical strategy for intraductal papillary mucinous neoplasms of the pancreas. Surg Today 2019; 50:50-55. [PMID: 31807871 PMCID: PMC6923258 DOI: 10.1007/s00595-019-01931-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/08/2019] [Indexed: 12/17/2022]
Abstract
The current treatment strategy for intraductal papillary mucinous neoplasms (IPMNs), based on the international consensus guideline, has been accepted widely. However, reported outcomes after surgical resection for IPMN show that once the tumor progresses to invasive intraductal papillary mucinous carcinoma (IPMC), recurrence is not uncommon. The surgical treatment for IPMN is invasive and sometimes followed by complications. Therefore, the best timing for resection might be at the point when high-grade dysplasia (HGD) is evident. According to previous reports, main duct type IPMN has a high malignant potential and its surgical resection is universally accepted, whereas, the incidence of HGD/invasive IPMC in branch duct and mixed type IPMNs is thought to be lower. In addition to mural nodules and a dilated main pancreatic duct, cytology and measurement of the carcinoembryonic antigen level in the pancreatic juice might be useful to differentiate HGD/invasive IPMC from low-grade dysplasia. The nomogram proposed recently to predict the risk of HGD/invasive IPMC in IPMN patients might help surgeons decide on the best treatment strategy, depending on the patient's age and general condition. Second resection for high-risk lesions in the remnant pancreas might improve the survival of IPMN patients.
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Affiliation(s)
- Seiko Hirono
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
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22
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Li Y, Li Y. Central versus Distal Pancreatectomy for Benign or Low-Grade Malignant Lesions in the Pancreatic Neck and Proximal Body. Am Surg 2019. [DOI: 10.1177/000313481908501130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The purpose of this meta-analysis was to compare the clinical outcomes of central pancreatectomy (CP) with distal pancreatectomy (DP). PubMed, Web of Knowledge, and Ovid's database were searched for studies published in English language between January 1990 and December 2018. A meta-analysis was performed to compare the clinical outcomes of CP versus DP. Nineteen trials with 1440 patients were analyzed. Although there were no significant differences in the rate of intra-operative blood transfusion between two groups, CP costs more operative time as well as had more intraoperative blood loss than DP. Furthermore, the overall complication rate, pancreatic fistula rate, and the clinically significant pancreatic fistula rate were significantly higher in the CP group. On the other hand, CP had a lower risk of endocrine (odds ratio: 0.17; 95% confidence interval: 0.10, 0.29; P < 0.05) and exocrine insufficiency (odds ratio: 0.22; 95% confidence interval: 0.10, 0.48; P < 0.05). CP was associated with a higher pancreatic fistula rate, and it should be performed in selected patients who need preservation of the pancreas, which is of utmost importance.
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Affiliation(s)
- Yangjun Li
- Department of Surgical Oncology, HwaMei Hospital, University Of Chinese Academy of Sciences, Ningbo, China
| | - Yujie Li
- Department of Surgical Oncology, HwaMei Hospital, University Of Chinese Academy of Sciences, Ningbo, China
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23
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Dragomir MP, Sabo AA, Petrescu GED, Li Y, Dumitrascu T. Central pancreatectomy: a comprehensive, up-to-date meta-analysis. Langenbecks Arch Surg 2019; 404:945-958. [PMID: 31641855 DOI: 10.1007/s00423-019-01829-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/23/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Central pancreatectomy (CP) is the alternative to distal pancreatectomy (DP) for specific pathologies of the mid-pancreas. However, the benefits of CP over DP remain controversial. This study aims to compare the two procedures by conducting a meta-analysis of all published papers. METHODS A systematic search of original studies comparing CP vs. DP was performed using PubMed, Scopus, and Cochrane Library databases up to June 2018. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist was followed. RESULTS Twenty-one studies were included (596 patients with CP and 1070 patients with DP). Compared to DP, CP was associated with significantly higher rates of overall and severe morbidity (p < 0.0001), overall and clinically relevant pancreatic fistula (p < 0.0001), postoperative hemorrhage (p = 0.02), but with significantly lower incidences of new-onset (p < 0.0001) and worsening diabetes mellitus (p = 0.004). Furthermore, significantly longer length of hospital stay (p < 0.0001) was observed for CP patients. CONCLUSIONS CP is superior to DP regarding the preservation of pancreatic functions, but at the expense of significantly higher complication rates and longer hospital stay. Proper selection of patients is of utmost importance to maximize the benefits and mitigate the risks of CP.
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Affiliation(s)
- Mihnea P Dragomir
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of General Surgery and Liver Transplantation, Division of Surgical Oncology, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Street, 022328, Bucharest, Romania.,Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexandru A Sabo
- Department of Pediatrics, "Marie S. Curie" Emergency Clinical Hospital for Children, Bucharest, Romania
| | | | - Yongfeng Li
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Traian Dumitrascu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. .,Department of General Surgery and Liver Transplantation, Division of Surgical Oncology, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Street, 022328, Bucharest, Romania.
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24
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Gharios J, Hain E, Dohan A, Prat F, Terris B, Bertherat J, Coriat R, Dousset B, Gaujoux S. Pre- and intraoperative diagnostic requirements, benefits and risks of minimally invasive and robotic surgery for neuroendocrine tumors of the pancreas. Best Pract Res Clin Endocrinol Metab 2019; 33:101294. [PMID: 31351817 DOI: 10.1016/j.beem.2019.101294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pancreatic neuroendocrine tumours (PanNET) are rare tumours, accounting for 1%-2% of all pancreatic neoplasms. These tumors are classified as functioning neuroendocrine tumours (F-PanNETs) or non-functioning (NF-PanNETs) depends on whether the tumour is associated with clinical hormonal hypersecretion syndrome or not. In the last decades, diagnosis of PanNETs has increased significantly due to the widespread of cross-sectional imaging. Whenever possible, surgery is the cornerstone of PanNETs management and the only curative option for these patients. Indeed, after R0 resection, the 5-year overall survival rate is around 90-100% for low grade lesions but significantly drops after incomplete resections. Compared to standard resections, pancreatic sparing surgery, i.e. enucleation and central pancreatectomy, significantly decreased the risk of pancreatic insufficiency. It should be performed in patients with good general condition and normal pancreatic function to limit the operative risk and enhance the benefit of surgery. Nowadays, due to many known advantages of minimally invasive surgery, there is an ongoing trend towards laparoscopic and robotic pancreatic surgery. The aim of this study is to describe the pre- and intraoperative diagnostic requirements for the management of PanNETs and the benefits and risks of minimally invasive surgery including laparoscopic and robotic approach in view of the recent literature.
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Affiliation(s)
- Joseph Gharios
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris, France
| | - Elisabeth Hain
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris, France
| | - Anthony Dohan
- Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, France; Department of Radiology, Cochin Hospital, APHP, Paris, France
| | - Fréderic Prat
- Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, France; Department of Gastroenterology, Cochin Hospital, APHP, Paris, France
| | - Benoit Terris
- Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, France; Department of Pathology, Cochin Hospital, APHP, Paris, France
| | - Jérôme Bertherat
- Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, France; Department of Endocrinology, Cochin Hospital, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris, France
| | - Romain Coriat
- Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, France; Department of Gastroenterology, Cochin Hospital, APHP, Paris, France
| | - Bertrand Dousset
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris, France; Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Sébastien Gaujoux
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris, France; Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, France.
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25
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Du B, Wang X, Wang X, Shah S, Ke N. A rare case of central pancreatectomy for isolated complete pancreatic neck transection trauma. BMC Surg 2019; 19:91. [PMID: 31299958 PMCID: PMC6626428 DOI: 10.1186/s12893-019-0557-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/03/2019] [Indexed: 02/05/2023] Open
Abstract
Background Pancreatic trauma accounts for only 0.2% of blunt trauma and 1–12% of penetrating injuries. Injuries to other organs, such as spleen, liver, or kidney, are associated with 50.5% of the cases. The isolated complete traumatic transection of the pancreatic neck is rare. In the past, pancreatoduodenectomy or distal pancreatectomy and splenectomy was the standard care for patients with traumatic transection of the pancreatic head, duodenum or distal pancreas, and pancreatic neck. However, limited cases have been reported on the central pancreatectomy for pancreatic neck injuries. We present a rare case of a 21-year-old male patient who received central pancreatectomy for isolated complete traumatic transection of the pancreatic neck. Case presentation A 21-year-old male patient with mild abdominal pain and showed no apparent abnormality in the initial abdominal computed tomography (CT) was brought to the local hospital’s emergency department due to a traffic accident. The patient’s abdominal pain became progressively worse during observation in the hospital that led to the patient being referred to our hospital. The patient’s vital signs were stable, and a physical examination revealed marked tenderness and rebound pain throughout the abdomen. The patient’s white blood cells were increased; The serum amylase and lipase levels were elevated. The abdominal computed tomography revealed pancreatic neck parenchymal discontinuity, peripancreatic effusion, and hemorrhage. The patient underwent exploratory laparotomy. Intraoperative examination identified the neck of the pancreas was completely ruptured, and no apparent abnormalities were observed in the other organs. The patient underwent central pancreatectomy and Roux -Y pancreaticojejunostomy. The patient was treated with antibiotics, acid inhibition and nutritional supports for 10 days after surgery. Symptoms of the patient were significantly relieved, and white blood cells, serum amylase, and lipase levels returned to normal. The patient underwent follow up examination for 6 months with no evidence of exocrine or endocrine insufficiency. Conclusions Central pancreatectomy is an effective pancreas parenchyma preserving procedure, may be a promising alternative to distal pancreatectomy and splenectomy for this complex pancreatic trauma in hemodynamically stable patients. Patient selection and surgeon experience are crucial in the technical aspects of this procedure.
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Affiliation(s)
- Bingqing Du
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xin Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xing Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Shashi Shah
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Nengwen Ke
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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26
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Tan Z, Chen P, Dong Z, Zhou B, Guo WD. Clinical efficacy of middle pancreatectomy contrasts distal pancreatectomy: a single-institution experience and review of literature. ANZ J Surg 2019; 89:E184-E189. [PMID: 30900350 PMCID: PMC6593708 DOI: 10.1111/ans.15095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/04/2018] [Accepted: 01/10/2019] [Indexed: 01/11/2023]
Abstract
Background We aim to analyse the difference of clinical efficacy between middle pancreatectomy (MP) and distal pancreatectomy (DP). Methods A retrospective study was used to analyse 39 cases of MP and 52 cases of DP from the Department of Hepatopancreatobiliary Surgery of the Affiliated Hospital of Qingdao University from February 2007 to December 2016. Furthermore, we identify randomized controlled trials or strictly designed clinical controlled trials on MP and DP. We performed a meta‐analysis of the final included studies using RevMan 5.3 software to illustrate the differences in efficacy between MP and DP. Results In the MP group, the operation time and diet start time were significantly longer than DP group. However, there was no significant difference in serious complications including clinically significant pancreatic fistula (grades B and C), delayed gastric emptying, reoperative and mortality. Furthermore, compared with DP, patients in MP group could benefit from long‐term post‐operative exocrine and endocrine function. Finally, we performed a meta‐analysis including 14 studies with a total of 1104 patients and proved that the pancreatic fistula rate, endocrine and exocrine function were significantly different in the two groups. Conclusion The MP is a safe and feasible surgical method. It can well preserve the endocrine and exocrine function of pancreas and improve the life quality of patients.
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Affiliation(s)
- Zhen Tan
- Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peng Chen
- Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zheng Dong
- Department of Plastic and Cosmetological Surgery, Medical School Hospital of Qingdao University, Qingdao, China
| | - Bin Zhou
- Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Dong Guo
- Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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27
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Xiao W, Zhu J, Peng L, Hong L, Sun G, Li Y. The role of central pancreatectomy in pancreatic surgery: a systematic review and meta-analysis. HPB (Oxford) 2018; 20:896-904. [PMID: 29886106 DOI: 10.1016/j.hpb.2018.05.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this systematic review and meta-analysis was to compare the clinical outcomes of central pancreatectomy (CP) with distal pancreatectomy (DP) and pancreaticoduodenectomy (PD). METHODS A systematic literature research in PubMed/Medline, Embase and Cochrane Library was performed to identify articles reporting CP from January 1983 to November 2017. RESULTS Fifty studies with 1305 patients undergoing CP were identified. The overall morbidity, mortality, pancreatic fistula (PF) rate and reoperation rate was 51%, 0.5%, 35% and 4% respectively. Endocrine and exocrine insufficiency were occurred in 4% and 5% of patients after CP. Meta-analysis of CP versus DP favored CP with regard to less blood loss (WMD = -143.4, P = 0.001), lower rates of endocrine (OR = 0.13, P < 0.001) and exocrine insufficiency (OR = 0.38, P < 0.001). CP was associated with higher morbidity and PF rate. In comparison with PD, CP had a lower risk of endocrine (OR = 0.14, P < 0.001) and exocrine insufficiency (OR = 0.14, P < 0.001), but a higher PF rate (OR = 1.6, P = 0.015). CONCLUSIONS CP maintains pancreatic endocrine and exocrine function better than DP and PD, but is associated with a higher PF rate.
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Affiliation(s)
- Weidong Xiao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Jisheng Zhu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Long Peng
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Le Hong
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Gen Sun
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Lv A, Qian HG, Qiu H, Wu JH, Hao CY. Is Central Pancreatectomy Truly Recommendable? A 9-Year Single-Center Experience. Dig Surg 2017; 35:532-538. [PMID: 29275422 DOI: 10.1159/000485806] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 11/27/2017] [Indexed: 01/04/2023]
Abstract
AIMS To compare the short- and long-term outcomes in patients with pancreatic benign or borderline neoplasm who underwent central pancreatectomy (CP) and distal pancreatectomy (DP). METHODS The inclusion criteria were as follows: (1) single benign or low-grade malignant tumor; (2) tumor confined to the pancreatic neck or proximal body; and (3) tumor amenable to either CP or DP. Short and long-term outcomes, including complications, pancreatic exocrine and endocrine function, and quality of life (QoL) were analyzed retrospectively. RESULTS Sixteen patients who underwent CP and 26 patients who underwent DP were included. The median follow-up period was 53 months (range 21-117 months). Patients undergoing CP were significantly more likely to experience complications (68.7 vs. 23%, p = 0.003) especially grade B/C postoperative pancreatic fistula (62.5 vs. 23%, p = 0.011) than those undergoing DP. During the long-term follow-up, 2 patients in the DP group developed new-onset diabetes mellitus, but no patient in CP group developed this condition (8 vs. 0%, p = 0.382). Evidence of exocrine insufficiency, including severe diarrhea or steatorrhea, was not observed in either group. Both groups were equally satisfied with the overall health status and overall QoL. CONCLUSION CP is associated with excellent pancreatic function but a significantly increased postoperative morbidity and risk compared to DP. Therefore, the indication of CP should be chosen strictly.
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Hwang HK, Park J, Choi SH, Kang CM, Lee WJ. Predicting new-onset diabetes after minimally invasive subtotal distal pancreatectomy in benign and borderline malignant lesions of the pancreas. Medicine (Baltimore) 2017; 96:e9404. [PMID: 29390555 PMCID: PMC5758257 DOI: 10.1097/md.0000000000009404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The purpose of this study was to evaluate the time-dependent probability and risk factors of pancreatogenic diabetes mellitus (PDM) in patients who underwent minimally invasive subtotal distal pancreatectomy.Changes in glucose metabolic consequence of 34 patients (laparoscopic: 31, robotic: 3) who underwent surgery from December 2005 to December 2014 were estimated by assessing impaired fasting glucose, PDM, and PDM-free time analysis.A total of 22 patients showed glucose intolerance, including 13 (38.2%) with impaired fasting glucose and 9 (26.5%) with PDM. The median onset time of PDM was 6.8 months (range 5.3-13.2 months). The PDM-free time probability according to time interval was 94.1% (6 months), 75.9% (12 months), and 72.6% (18 months). It was shown that body mass index>23 kg/m (49.9 vs 87.9 months, P = .020) and preoperative cholesterol >200 mg/dL (40.9 vs 85.2 months, P = .003) adversely influenced PDM-free time. Preoperative cholesterol >200 mg/dL (hazard ratio = 6.172; 95% confidence interval, 1.532-24.865; P = .010) was significantly associated with short PDM-free time in Cox proportional hazards model.Patients with high cholesterol levels and high BMI should be closely monitored for the development of PDM.
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Affiliation(s)
- Ho Kyoung Hwang
- Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul
- Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul
| | - Jiae Park
- Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul
- Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul
| | - Sung Hoon Choi
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chang Moo Kang
- Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul
- Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul
| | - Woo Jung Lee
- Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul
- Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul
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30
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Dumitrascu T, Scarlat A, Ionescu M, Popescu I. Central pancreatectomy: an oncologically safe option to treat metastases of other neoplasms of the mid-portion of the pancreas? Ann Hepatobiliary Pancreat Surg 2017; 21:76-79. [PMID: 28567450 PMCID: PMC5449367 DOI: 10.14701/ahbps.2017.21.2.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/22/2016] [Accepted: 09/26/2016] [Indexed: 01/05/2023] Open
Abstract
Backgrounds/Aims Standard pancreatic resections are the current approach for patients with resectable, isolated pancreatic metastases of other neoplasms. However, the role of parenchyma-sparing pancreatectomies for such pathology is poorly investigated. The aim of the present study is to assess the oncological safety of central pancreatectomies for pancreatic metastases of other neoplasms. Methods A literature search was performed in order to identify patients with central pancreatectomies for pancreatic metastases of other neoplasms. The available data of the patients were extracted and analyzed. Results A total number of 16 patients were identified. Renal carcinoma was the primary origin for the largest number of these patients (11 patients - 69%). The mean overall survival time was 109 months, with 1-, 5- and 10-year survival rates of 100%, 84%, and 60%, respectively. Conclusions Although not often performed, a central pancreatectomy appears to be an oncologically safe surgical procedure in select patients with pancreatic metastases of other neoplasms of the pancreatic body and isthmus. However, no definitive conclusions should be drawn, based on the data provided in the present study, due to the limited number and heterogeneity of the patients.
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Affiliation(s)
- Traian Dumitrascu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
| | - Andra Scarlat
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihnea Ionescu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
| | - Irinel Popescu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
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31
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Zhang RC, Zhang B, Mou YP, Xu XW, Zhou YC, Huang CJ, Zhou JY, Jin WW, Lu C. Comparison of clinical outcomes and quality of life between laparoscopic and open central pancreatectomy with pancreaticojejunostomy. Surg Endosc 2017; 31:4756-4763. [DOI: 10.1007/s00464-017-5552-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/28/2017] [Indexed: 01/17/2023]
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Sabater L, Ausania F, Bakker OJ, Boadas J, Domínguez-Muñoz JE, Falconi M, Fernández-Cruz L, Frulloni L, González-Sánchez V, Lariño-Noia J, Lindkvist B, Lluís F, Morera-Ocón F, Martín-Pérez E, Marra-López C, Moya-Herraiz Á, Neoptolemos JP, Pascual I, Pérez-Aisa Á, Pezzilli R, Ramia JM, Sánchez B, Molero X, Ruiz-Montesinos I, Vaquero EC, de-Madaria E. Evidence-based Guidelines for the Management of Exocrine Pancreatic Insufficiency After Pancreatic Surgery. Ann Surg 2016; 264:949-958. [PMID: 27045859 DOI: 10.1097/sla.0000000000001732] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To provide evidence-based recommendations for the management of exocrine pancreatic insufficiency (EPI) after pancreatic surgery. BACKGROUND EPI is a common complication after pancreatic surgery but there is certain confusion about its frequency, optimal methods of diagnosis, and when and how to treat these patients. METHODS Eighteen multidisciplinary reviewers performed a systematic review on 10 predefined questions following the GRADE methodology. Six external expert referees reviewed the retrieved information. Members from Spanish Association of Pancreatology were invited to suggest modifications and voted for the quantification of agreement. RESULTS These guidelines analyze the definition of EPI after pancreatic surgery, (one question), its frequency after specific techniques and underlying disease (four questions), its clinical consequences (one question), diagnosis (one question), when and how to treat postsurgical EPI (two questions) and its impact on the quality of life (one question). Eleven statements answering those 10 questions were provided: one (9.1%) was rated as a strong recommendation according to GRADE, three (27.3%) as moderate and seven (63.6%) as weak. All statements had strong agreement. CONCLUSIONS EPI is a frequent but under-recognized complication of pancreatic surgery. These guidelines provide evidence-based recommendations for the definition, diagnosis, and management of EPI after pancreatic surgery.
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Affiliation(s)
- Luis Sabater
- *Department of Surgery, Hospital Clinico, University of Valencia, Valencia, Spain †Department of Surgery, Complejo Hospitalario Universitario de Vigo, Vigo, Spain ‡Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands §Department of Gastroenterology, Consorci Sanitari de Terrassa, Terrassa, Spain ¶Department of Gastroenterology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain ||Department of Surgery, Università Vita e Salute, Ospedale San Raffaele IRCCS, Milano, Italy **Department of Surgery, Institut de Malalties Digestives I Metabòliques, Hospital Clínic, IDIBAPS, Barcelona, Spain ††Department of Medicine, Pancreas Center, University of Verona, Verona, Italy ‡‡Department of Endocrinology and Nutrition, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain. §§Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ¶¶Department of Surgery, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain. ||||Department of Surgery, Hospital Universitario de La Princesa, Madrid, Spain ***Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain †††Unidad de Cirugía Hepato-bilio-pancreática y Trasplante, Hospital Universitari i Politecnic. La Fe, Valencia, Spain ‡‡‡NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK §§§Department of Gastroenterology, Hospital Clinico, University of Valencia, Valencia, Spain ¶¶¶Unit of Digestive Disease, Agencia Sanitaria Costa del Sol, Marbella, Málaga ||||||Department Digestive System, Sant'Orsola-Malpighi Hospital, Bologna, Italy ****Department of Surgery, Hospital Universitario de Guadalajara, Guadalajara, Spain ††††Department of HPB Surgery and Liver Transplantation, Hospital Carlos Haya, Malaga, Spain ‡‡‡‡Exocrine Pancreas Research Unit, Hospital Universitari Vall d'Hebron, Institut de Recerca, Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain §§§§Department of Digestive Surgery- Division of HBP Surgery, Hospital Universitario Donostia, San Sebastián, Spain ¶¶¶¶Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, IDIBAPS, CiberEHD, Barcelona, Spain ||||||||Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
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Robot-assisted laparoscopic versus open middle pancreatectomy: short-term results of a randomized controlled trial. Surg Endosc 2016; 31:962-971. [DOI: 10.1007/s00464-016-5046-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/11/2016] [Indexed: 01/04/2023]
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Abstract
Islet cell tumors of the pancreas, also known as pancreatic neuroendocrine tumors, constitute less than 5% of pancreatic tumors, and 7% of all neuroendocrine tumors. Most are non-functional, and patients often present with metastatic disease. Functional tumors present with distinct clinical syndromes. Accurate staging is critical as surgery is both the cornerstone of treatment, and the only hope for cure. Medical management involves treating the manifestations of hormonal excess, and using somatastatin analogues when appropriate. Systemic chemotherapy, targeted molecular therapy, and peptide receptor radiotherapy may be used for refractory disease in lieu of or as an adjunct to surgery.
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Affiliation(s)
- Sunil Amin
- Division of Gastroenterology, Department of Medicine Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1069, New York, NY 10029, USA
| | - Michelle Kang Kim
- Division of Gastroenterology, Department of Medicine Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1069, New York, NY 10029, USA.
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Beger HG, Siech M, Poch B, Mayer B, Schoenberg MH. Limited surgery for benign tumours of the pancreas: a systematic review. World J Surg 2015; 39:1557-66. [PMID: 25691214 DOI: 10.1007/s00268-015-2976-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Limited surgical procedures for benign cystic neoplasms and endocrine tumours of the pancreas have the potential advantage of pancreatic tissue sparing compared to standard oncological resections. METHODS Searching PubMed/MedLine, Embase and Cochrane Library identified 86 full papers: 25 reporting on enucleation (EN), 38 on central pancreatectomy (CP) and 23 on duodenum-preserving total/partial pancreatic head resection (DPPHRt/p). The results are based on analysis of data of 838, 912 and 431 patients for EN, CP and DPPHRt/s, respectively. RESULTS The indication for EN for cystic neoplasms and neuro-endocrine tumours to EN was 20.5 and 73 %; for CP 62.9 and 31 %; and for DPPHRt/p 69.6 and 10.2%, respectively. The estimated mean tumour sizes were in EN-group 2.4 cm, in CP-group 2.9 cm and in DPPHRt/p-group 3.1 cm (DPPHRt/p vs EN, p = 0.035). Postoperative severe complications developed after EN, CP and DPPHRt/p in 9.6, 16.8 and 11.5% of patients; pancreatic fistula in 36.7, 35.2 and 20.1%; and reoperation was required in 4.7, 6.5 and 1.8 %, respectively. Hospital mortality after EN was 0.95 %; after CP 0.72%; and after DPPHRt/p 0.49%. Compared to EN and CP, DPPHRt/p exhibited significant lower frequency of reoperation (p = 0.029, p < 0.001) and lower rate of fistula (p < 0.001; p = 0.001). CONCLUSION EN, CP and DPPHRt/p applied for benign tumours are associated with low surgery-related early postoperative morbidity, a very low hospital mortality and the advantages of conservation of pancreatic functions. However, the level of evidence for EN and CP compared to standard oncological resections appears presently low. There is a high level of evidence from prospective controlled trials regarding the significant maintenance of exocrine and endocrine pancreatic functions after DPPHRt/p compared to pancreato-duodenectomy.
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Affiliation(s)
- H G Beger
- Department of General-and Visceral Surgery, c/o University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany,
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Zhang RC, Zhou YC, Mou YP, Huang CJ, Jin WW, Yan JF, Wang YX, Liao Y. Laparoscopic versus open enucleation for pancreatic neoplasms: clinical outcomes and pancreatic function analysis. Surg Endosc 2015; 30:2657-65. [PMID: 26487211 DOI: 10.1007/s00464-015-4538-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 09/01/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND The studies comparing laparoscopic enucleation (LE) with open enucleation (OE) are limited. This study aimed to compare perioperative outcomes of patients undergoing LE and OE and to assess the pancreatic function after LE. METHODS Between February 2001 and July 2014, patients who underwent enucleation were reviewed. Patients were divided into two groups as LE and OE. Data considered for comparison analysis were patient demographics, intraoperative variables, morbidity, postoperative hospital stay, mortality, pathologic findings, and long-term follow-up (including pancreatic function). RESULTS Thirty-seven patients (15 LE and 22 OE) were included in the final analysis. Baseline characteristics were similar in the two groups. LE group showed significantly shorter operating time (118.2 ± 33.1 vs. 155.2 ± 44.3 min, p = 0.009), lower estimated blood loss (80.0 ± 71.2 vs. 195.5 ± 103.4 ml, p = 0.001), shorter first flatus time (1.8 ± 1.0 vs. 3.4 ± 1.8 days, p = 0.004), shorter diet start time (2.4 ± 1.0 vs. 4.4 ± 2.0 days, p = 0.001), shorter postoperative hospital stay (7.9 ± 3.4 vs. 11.2 ± 5.7 days, p = 0.046). Postoperative outcomes, including morbidity (40.0 vs. 45.5 %, p = 1.000), grade B/C pancreatic fistula rates (20.0 vs. 13.6 %, p = 0.874), and mortality, were similar in the two groups. The median follow-up period was 47 months (range 7-163 months). No local recurrence or distant metastasis was detected in either group. Only one patient (4.8 %) underwent OE developed new-onset diabetes, in comparison with none in the LE group. One patient (7.1 %) had weight loss and received pancreatic enzyme supplementation in the LE group, in comparison with two patients (9.5 %) in the OE group. CONCLUSIONS LE is a safe and feasible technique for the benign or low malignant-potential pancreatic neoplasms. Compared to OE, LE had shorter operating time, lower estimated blood loss, and faster recovery. LE could preserve the pancreatic function as the OE.
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Affiliation(s)
- Ren-Chao Zhang
- Department of General Surgery, Zhejiang Provincial People's Hospital, Wenzhou Medical University, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China
| | - Yu-Cheng Zhou
- Department of General Surgery, Zhejiang Provincial People's Hospital, Wenzhou Medical University, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China
| | - Yi-Ping Mou
- Department of General Surgery, Zhejiang Provincial People's Hospital, Wenzhou Medical University, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China.
| | - Chao-Jie Huang
- Department of General Surgery, Zhejiang Provincial People's Hospital, Wenzhou Medical University, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China
| | - Wei-Wei Jin
- School of Medicine, Zhejiang University, Hangzhou, 310029, Zhejiang Province, China
| | - Jia-Fei Yan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang Province, China
| | - Yong-Xiang Wang
- Department of General Surgery, Zhejiang Provincial People's Hospital, Wenzhou Medical University, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China
| | - Yi Liao
- Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China
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Hirono S, Murakami Y, Tani M, Kawai M, Okada KI, Uemura K, Sudo T, Hashimoto Y, Nakagawa N, Kondo N, Yamaue H. Identification of risk factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy using a 13C-labeled mixed triglyceride breath test. World J Surg 2015; 39:516-25. [PMID: 25318451 DOI: 10.1007/s00268-014-2832-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are only a few reports concerning long-term exocrine function after pancreaticoduodenectomy (PD), although the number of long-term survivors has increased. We assessed pancreatic exocrine function after PD in 189 patients to identify risk factors for pancreatic exocrine insufficiency. METHODS We evaluated patients' exocrine function by using the (13)C-labeled mixed triglyceride breath test, a noninvasive test feasible in outpatient service units. The present study included 99 patients that underwent pancreaticojejunostomy (PJ) at Wakayama Medical University Hospital and 90 patients that underwent pancreaticogastrostomy (PG) at Hiroshima University Hospital, the standard reconstruction techniques during PD at the respective hospitals. We also analyzed long-term morphological changes of remnant pancreas by computed tomography (main pancreatic duct dilation and parenchymal atrophy), nutritional status, and endocrine function. RESULTS Independent risk factors for exocrine insufficiency after PD include hard pancreas (P = 0.003, odds ratio; 3.157) and PG reconstruction (P = 0.040, odds ratio; 2.321). Breath test results correlated significantly with post-operative morphological changes, nutritional status, and endocrine function. Atrophic changes of the remnant pancreas in the PG group were more severe than those in the PJ group. Furthermore, for patients with a soft pancreas, postoperative body weight changes, prognostic nutritional index, serum total protein levels as well as exocrine test were worse in the PG group, compared with the PJ group. CONCLUSIONS Our results showed that PJ reconstruction might be superior to PG during PD, from the viewpoint of long-term pancreatic exocrine function, although further prospective studies are needed.
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Affiliation(s)
- Seiko Hirono
- Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan
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Cherif R, Gaujoux S, Cros J, Ruszniewski P, Sauvanet A. Parenchyma-sparing pancreatectomies for pancreatic neuroendocrine tumors. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2015. [DOI: 10.2217/ije.15.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Parenchyma-sparing pancreatectomy, including enucleation and central pancreatectomy, has been investigated as an alternative to standard resection (pancreaticoduodenectomy or left/distal pancreatectomy) for pancreatic neuroendocrine tumor (PNET). In selected patients, with small (<2 cm) and low-grade tumors, PSP are associated with excellent both overall and disease-free survivals. These procedures are associated with an increased postoperative morbidity but an excellent long-term postoperative pancreatic function. Therefore, they should be considered as a valid therapeutic option in selected well-differentiated PNET.
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Affiliation(s)
- Rim Cherif
- Department of Hepatobiliary & Pancreatic Surgery – Hospital Beaujon, 100, Bd du Général Leclerc - 92110 Clichy, France
| | - Sébastien Gaujoux
- Department of Hepatobiliary & Pancreatic Surgery – Hospital Beaujon, 100, Bd du Général Leclerc - 92110 Clichy, France
- UNITY Hospitalo-Universitary Department, Université Paris Diderot, Paris, France
| | - Jérome Cros
- Department of Pathology, Hopital Beaujon, Clichy, 92110, France
| | - Philippe Ruszniewski
- UNITY Hospitalo-Universitary Department, Université Paris Diderot, Paris, France
- Department of Gastroenterology, Pôle des Maladies de l'Appareil Digestif (PMAD), Hopital Beaujon, Clichy, 92110, France
| | - Alain Sauvanet
- Department of Hepatobiliary & Pancreatic Surgery – Hospital Beaujon, 100, Bd du Général Leclerc - 92110 Clichy, France
- UNITY Hospitalo-Universitary Department, Université Paris Diderot, Paris, France
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Nachulewicz P, Rogowski B, Obel M, Woźniak J. Central Pancreatectomy as a Good Solution in Frantz Tumor Resection: A Case Report. Medicine (Baltimore) 2015; 94:e1165. [PMID: 26200617 PMCID: PMC4603021 DOI: 10.1097/md.0000000000001165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Solid pseudopapillary tumors of the pancreas located in the head or body are a challenging clinical problem because they usually demand extensive surgical procedures, and in most reported cases pancreaticoduodenectomy is the operation of choice in such a location. An alternative method of surgery in precisely selected patients is a procedure known as central pancreatectomy. The authors present the case of a 13-year-old girl with a 5 cm tumor located in the body of the pancreas. The favorable anatomical location of the tumor suggested central pancreatic resection. The tumor was excised with 1 cm oncologic margins from both sides, and the distal remnant of the pancreas was protected with a Roux-en-Y loop. In the postoperative period the patient required reoperation because of intensive bleeding in the resection site but the duodenal loop was saved and the patient protected from biliary tract reconstruction and exocrine and endocrine insufficiency. Progress in pancreatic surgery, especially in children, allows less radical options for the reason that preservation of endocrine and exocrine function is very important and protects them, especially from insulin-dependent diabetes in the future.
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Affiliation(s)
- Pawel Nachulewicz
- From the Clinic of Paediatric Surgery and Traumatology, Medical University of Lublin, Lublin, Poland
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40
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Abstract
OBJECTIVE The true rate of new-onset diabetes (NODM) after distal pancreatectomy (DP) is not known. This systematic review was carried out to obtain exact percentages regarding the incidence of NODM after DP for different indications. BACKGROUND Distal pancreatectomy is the standard procedure for removal of benign or (potentially) malignant lesions from the pancreatic body or tail and increasingly used for removal of often benign lesions. It is associated with low mortality rates, though postoperative diabetes remains a serious problem. METHODS Embase, PubMed, Medline, Web of Science, the Cochrane Library, and Google Scholar were searched for articles reporting incidence of NODM after DP. Methodological quality of the included studies was assessed by means of the Newcastle-Ottawa scale for cohort studies and the Moga scale for case series. Mean weighted overall percentages of NODM after DP for different indications were calculated with 95% confidence intervals (CI) and corresponding P values. RESULTS Twenty-six studies were included, comprising 1.731 patients undergoing DP. The average cumulative incidence of NODM after DP performed for chronic pancreatitis was 39% and for benign or (potentially) malignant lesions it was 14%. Comparing the proportions of these 2 groups showed a significant difference (95% CI: 0.351-0.434 and 0.110-0.172, respectively, P < 0.000). The average percentage of insulin-dependent diabetes among patients with NODM after DP was 77%. CONCLUSIONS This review is the largest of its kind to assess the cumulative incidence of NODM after DP and shows that NODM is a frequently occurring complication, with incidence depending on the preexisting disease and follow-up time. Because NODM can affect quality of life, patients undergoing DP should be preoperatively provided with this information as specific as possible.
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Lombardi M, De Lio N, Funel N, Sardella C, Russo D, Urbani C, Rossi G, Campani D, Martino E, Marcocci C, Boggi U, Bogazzi F. Prognostic factors for pancreatic neuroendocrine neoplasms (pNET) and the risk of small non-functioning pNET. J Endocrinol Invest 2015; 38:605-13. [PMID: 25501604 DOI: 10.1007/s40618-014-0219-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 11/24/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Non-functioning (NF) pancreatic neuroendocrine tumors (pNET) often have an indolent outcome. A consensus to submit patients with large (>2 cm) NF-pNET to surgery already exists; but a conservative approach for small (≤2 cm) NF neoplasms has been proposed. AIM To identify prognostic factors for survival and progression free survival (PFS) of NF-pNET, evaluating whether surgery may be avoided for small NF-pNET. SUBJECTS AND METHODS Retrospective study of 77 consecutive patients with pNET submitted to surgery, of which 60 were NF. Pathological tissues were revised according to the 2000 and 2010 WHO classifications. Risk factors for survival and PFS were evaluated using the Kaplan-Meier method and the Cox regression model. RESULTS The 8-year cause-specific survival of NF-pNET was 79.3%. At univariate analysis, high grading, high staging, large tumors, angioinvasion and peri-pancreatic infiltration were significantly associated with a shorter survival; at multivariate analysis only peri-pancreatic infiltration was significantly associated with a shorter NF-pNET survival. Most small NF-pNET were grade 1 (74%), compared to large NF-pNET (27%). Distant metastases were present in 29.7% (n = 11) and 17.4% (n = 4) of patients with large or small NF-pNET, respectively; among the 19 small NF-pNET without metastasis, five had a local malignancy (lymph node metastasis or local infiltration); thus, 39% of the 23 NF-pNET, turned out to have a malignant potential. CONCLUSIONS Among NF-pNET, large neoplasms were associated with worse outcomes; however, small NF-pNET do not seem to have an invariable benign behavior. Whether surgery should be avoided in all patients with small NF-pNET is questionable.
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Affiliation(s)
- M Lombardi
- Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56124, Pisa, Italy.
| | - N De Lio
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - N Funel
- Department of Surgical, Medical and Molecular Pathology of Critical Area, University of Pisa, Pisa, Italy
| | - C Sardella
- Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56124, Pisa, Italy
| | - D Russo
- Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56124, Pisa, Italy
| | - C Urbani
- Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56124, Pisa, Italy
| | - G Rossi
- Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - D Campani
- Department of Surgical, Medical and Molecular Pathology of Critical Area, University of Pisa, Pisa, Italy
| | - E Martino
- Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56124, Pisa, Italy
| | - C Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56124, Pisa, Italy
| | - U Boggi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - F Bogazzi
- Department of Clinical and Experimental Medicine, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56124, Pisa, Italy
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Kang CM, Lee JH, Lee WJ. Minimally invasive central pancreatectomy: current status and future directions. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 21:831-840. [DOI: 10.1002/jhbp.143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Chang Moo Kang
- Department of Surgery; Yonsei University College of Medicine; Pancreaticobiliary Cancer Clinic; Yonsei Cancer Center; Severance Hospital; 50 Yonsei-ro, Seodaemun-ku Seoul 120-752 Korea
| | - Jin Ho Lee
- Department of Surgery; Yonsei University College of Medicine; Pancreaticobiliary Cancer Clinic; Yonsei Cancer Center; Severance Hospital; 50 Yonsei-ro, Seodaemun-ku Seoul 120-752 Korea
| | - Woo Jung Lee
- Department of Surgery; Yonsei University College of Medicine; Pancreaticobiliary Cancer Clinic; Yonsei Cancer Center; Severance Hospital; 50 Yonsei-ro, Seodaemun-ku Seoul 120-752 Korea
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Tani M, Kawai M, Hirono S, Okada KI, Miyazawa M, Shimizu A, Kitahata Y, Yamaue H. Randomized clinical trial of isolated Roux-en-Y versus conventional reconstruction after pancreaticoduodenectomy. Br J Surg 2014; 101:1084-91. [PMID: 24975853 DOI: 10.1002/bjs.9544] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 04/02/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) is associated with a high incidence of postoperative complications including pancreatic fistula. This randomized clinical trial compared the incidence of pancreatic fistula between the isolated Roux-en-Y (IsoRY) and conventional reconstruction (CR) methods. METHODS Patients admitted for PD between June 2009 and September 2012 in a single centre were assigned randomly to CR or IsoRY. The primary endpoint was the incidence of pancreatic fistula (grade A-C) defined according to the International Study Group on Pancreatic Fistula. Secondary endpoints were complication rates, mortality and hospital stay. Multiple logistic regression analysis was performed to identify factors associated with pancreatic fistula. RESULTS Some 153 patients were randomized, 76 to CR and 77 to IsoRY; two patients from the IsoRY group were excluded after randomization. Pancreatic fistula occurred in 26 patients (34 per cent) in the CR group and 25 (33 per cent) in the IsoRY group (P = 0·909). The number of patients with a clinically relevant pancreatic fistula (grade B or C) was similar in the two groups (10 and 11 patients respectively; P = 0·789), as were complication rates (42 versus 40 per cent; P = 0·793) and mortality (none in either group; P = 0·999). Soft pancreas was the only independent risk factor for pancreatic fistula (odds ratio 4·42, 95 per cent confidence interval 1·85 to 10·53; P <0·001). CONCLUSION This study showed that IsoRY reconstruction does not reduce the incidence of pancreatic fistula compared with CR. REGISTRATION NUMBER NCT00915863 (http://www.clinicaltrials.gov/) and UMIN000001967 (http://www.umin.ac.jp/).
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Affiliation(s)
- M Tani
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera,, Wakayama, 641-8510, Japan
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Beger HG, Poch B, Vasilescu C. Benign cystic neoplasm and endocrine tumours of the pancreas--when and how to operate--an overview. Int J Surg 2014; 12:606-14. [PMID: 24742543 DOI: 10.1016/j.ijsu.2014.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 03/31/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND The recent evolution of limited local operative procedures for benign pancreatic lesions shifted surgical treatment options to the application of local techniques, although major resections of pancreatic head and left resection are still the standard. OBJECTIVES To evaluate the level of evidence of tumour enucleation (EN), pancreatic middle segment resection (PMSR) and duodenum preserving total/subtotal pancreatic head resection (DPPHRt/s), we focus based on present knowledge on indication to surgical treatment evaluating the questions, when and how to operate. RESULTS Tumour enucleation is recommended for all symptomatic neuro-endocrine tumours with size up to 2-3 cm and non-adherence to pancreatic main-ducts. EN has been applied predominantly in neuro-endocrine tumours and less frequently in cystic neoplasms. 20% of enucleation are performed as minimal invasive laparascopic procedure. Surgery related severe post-operative complications with the need of re-intervention are observed in about 11%, pancreatic fistula in 33%. The major advantage of EN are low procedure related early post-operative morbidity and a very low hospital mortality. PMSR is applied in two thirds for symptomatic cystic neoplasm and in one third for neuro-endocrine tumours. The high level of 33% pancreatic fistula and severe post-operative complications of 18% is related to management of proximal pancreatic stump. DPPHRt/s is used in 70% for symptomatic cystic neoplasms, for lesions with risk for malignancy and in less than 10% for neuro-endocrine tumours. DPPHRt with segment resection of peripapillary duodenum and intra-pancreatic common bile duct has been applied in one third of patients and in two thirds by complete preservation of duodenum and common bile duct. The level of evidence for EN and PMSR is low because of retrospective data evaluation and absence of RCT results. For DPPHR, 7 prospective, controlled studies underline the advantages compared to partial pancreaticoduodenectomy. CONCLUSION The application of tumour enucleation, pancreatic middle segment resection and duodenum preserving subtotal or total pancreatic head resection are associated with low level surgery related early post-operative complications and a very low hospital mortality. The major advantage of the limited procedures is preservation of exo- and endocrine pancreatic functions.
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Affiliation(s)
- H G Beger
- Department of General- and Visceral Surgery, c/o University of Ulm, Ulm, Germany.
| | - B Poch
- Center of Oncologic, Endocrine and Minimal Invasive Surgery, Donouklinikum Neu-Ulm, Germany
| | - C Vasilescu
- Department of General Surgery and Liver Transplantation, Fundei Clinical Institute, Bucharest, Romania
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Balzano G, Carvello M, Piemonti L, Nano R, Ariotti R, Mercalli A, Melzi R, Maffi P, Braga M, Staudacher C. Combined laparoscopic spleen-preserving distal pancreatectomy and islet autotransplantation for benign pancreatic neoplasm. World J Gastroenterol 2014; 20:4030-4036. [PMID: 24744593 PMCID: PMC3983459 DOI: 10.3748/wjg.v20.i14.4030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 02/05/2013] [Accepted: 03/07/2013] [Indexed: 02/07/2023] Open
Abstract
AIM: To evaluate the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with autologous islet transplantation (AIT) for benign tumors of the pancreatic body-neck.
METHODS: Three non-diabetic, female patients (age 37, 44 and 35 years, respectively) were declared candidates for surgery, between May and September 2011, because of pancreatic body/neck cystic lesions. The planned operation was an LSPDP associated with AIT from the normal pancreas distal to the neoplasm. Islets isolation was performed on the residual pancreatic parenchyma after frozen section examination of the margin. Purified autologous islets were infused into the portal vein by a percutaneous transhepatic approach the day after surgery.
RESULTS: The procedure was performed successfully in all the three cases, and the spleen was preserved along with its vessels. Mean operation time was 283 ± 52 min and average blood loss was 133 ± 57 mL. Residual pancreas weights were 33, 22 and 30 g, and 105.200, 40.390 and 94.790 islet equivalents were isolated, respectively. Surgical complications occurred in one patient (grade A pancreatic fistula). Postoperative stays were 6, 6 and 7 d, respectively. Histopathological evaluation revealed mucinous cystic neoplasm in cases 1 and 3, and serous cystic neoplasm in patient 2. No postoperative insulin administration was required. One patient developed a transient partial portal thrombosis 2 mo after islet infusion. Patients are insulin independent at a mean follow up of 8 ± 2 mo.
CONCLUSION: Combination of LSPDP and AIT is feasible and could be effective to minimize the surgical impact for benign neoplasm of pancreatic body-neck.
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Zhou YM, Zhang XF, Wu LP, Su X, Li B, Shi LH. Pancreatic fistula after central pancreatectomy: case series and review of the literature. Hepatobiliary Pancreat Dis Int 2014; 13:203-8. [PMID: 24686549 DOI: 10.1016/s1499-3872(14)60032-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Postoperative pancreatic fistula is one of the most common complications after pancreatectomy. This study aimed to assess the occurrence and severity of pancreatic fistula after central pancreatectomy. METHODS The medical records of 13 patients who had undergone central pancreatectomy were retrospectively studied, together with a literature review of studies including at least five cases of central pancreatectomy. Pancreatic fistula was defined and graded according to the recommendations of the International Study Group on Pancreatic Fistula (ISGPF). RESULTS No death was observed in the 13 patients. Pancreatic fistula developed in 7 patients and was successfully treated non-operatively. None of these patients required re-operation. A total of 40 studies involving 867 patients who underwent central pancreatectomy were reviewed. The overall pancreatic fistula rate of the patients was 33.4% (0-100%). Of 279 patients, 250 (89.6%) had grade A or B fistulae of ISGPF and were treated non-operatively, and the remaining 29 (10.4%) had grade C fistulae of ISGPF. In 194 patients, 15 (7.7%) were re-operated upon. Only one patient with grade C fistula of ISGPF died from multiple organ failure after re-operation. CONCLUSION Despite the relatively high occurrence, most pancreatic fistulae after central pancreatectomy are recognized a grade A or B fistula of ISGPF, which can be treated conservatively or by mini-invasive approaches.
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Affiliation(s)
- Yan-Ming Zhou
- Department of Hepatobiliary & Pancreatovascular Surgery, First Affiliated Hospital of Xiamen University; Oncologic Center of Xiamen, Xiamen 361003, China.
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Iacono C, Verlato G, Ruzzenente A, Campagnaro T, Bacchelli C, Valdegamberi A, Bortolasi L, Guglielmi A. Systematic review of central pancreatectomy and meta-analysis of central versus distal pancreatectomy. Br J Surg 2013; 100:873-85. [PMID: 23640664 DOI: 10.1002/bjs.9136] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Central pancreatectomy (CP) is a parenchyma-sparing surgical procedure that enables the removal of benign and/or low-grade malignant lesions from the neck and proximal body of the pancreas. The aim of this review was to evaluate the short- and long-term surgical results of CP from all published studies, and the results of comparative studies of CP versus distal pancreatectomy (DP). METHODS Eligible studies published between 1988 and 2010 were reviewed systematically. Comparisons between CP and DP were pooled and analysed by meta-analytical techniques using random- or fixed-effects models, as appropriate. RESULTS Ninety-four studies, involving 963 patients undergoing CP, were identified. Postoperative morbidity and pancreatic fistula rates were 45·3 and 40·9 per cent respectively. Endocrine and exocrine pancreatic insufficiency was reported in 5·0 and 9·9 per cent of patients. The overall mortality rate was 0·8 per cent. Compared with DP, CP had a higher postoperative morbidity rate and a higher incidence of pancreatic fistula, but a lower risk of endocrine insufficiency (relative risk (RR) 0·22, 95 per cent confidence interval 0·14 to 0·35; P < 0·001). The risk of exocrine failure was also lower after CP, although this was not significant (RR 0·59, 0·32 to 1·07; P = 0·082). CONCLUSION CP is a safe procedure with good long-term functional reserve. In situations where DP represents an alternative, CP is associated with a slightly higher risk of early complications.
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Affiliation(s)
- C Iacono
- Department of Surgery, Unit of Hepato-Biliary-Pancreatic Surgery, Verona, Italy.
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Xu SB, Zhu YP, Zhou W, Xie K, Mou YP. Patients get more long-term benefit from central pancreatectomy than distal resection: a meta-analysis. Eur J Surg Oncol 2013; 39:567-74. [PMID: 23465182 DOI: 10.1016/j.ejso.2013.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 01/16/2013] [Accepted: 02/01/2013] [Indexed: 01/18/2023] Open
Abstract
AIMS Central pancreatectomy (CP) protects more normal pancreatic parenchyma than distal pancreatectomy (DP), but the safety, feasibility and long-term benefit of CP are inconclusive. This meta-analysis aims to ascertain the relative merits of CP. METHODS A systematic literature research was performed to identify comparative studies on CP and DP. Perioperative and long-term outcomes constituted the end points. Pooled risk ratios (RR) and weighted mean differences (WMD) with 95% confidence intervals (95% CI) were calculated using either fixed effects or random effects model. RESULTS Nine studies with 735 patients were included in this meta-analysis. Although CP cost more operative time than DP, the two groups had no significant differences in the volume of intraoperative blood loss, rate of intraoperative blood transfusion and length of postoperative hospital stay. According to the postoperative outcomes, although the CP group had higher overall complication rate (Fixed effects model; RR: 1.30; 95% CI: 1.05-1.62; P < 0.05) as well as overall pancreatic fistula rate (Fixed effects model; RR: 1.58; 95% CI: 1.20-2.08; P < 0.05), the two groups did not differ significantly in the fateful surgical complications such as clinically significant pancreatic fistula (Grades B and C), postoperative bleeding, reoperation and intra-abdominal effusion/abscess. Furthermore, the perioperative mortality rate was comparable between the two groups. During the follow-up period, the patients after DP were more likely to suffer pancreatic exocrine insufficiency (Fixed effects model; RR: 0.53; 95% CI: 0.32-0.86; P < 0.05) and endocrine impairment (Fixed effects model; RR: 0.19; 95% CI: 0.11-0.33; P < 0.05). CONCLUSION CP was still an acceptable and feasible procedure, especially when considering the postoperative pancreatic function preservation ability by CP.
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Affiliation(s)
- S B Xu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, China.
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Du ZY, Chen S, Han BS, Shen BY, Liu YB, Peng CH. Middle segmental pancreatectomy: A safe and organ-preserving option for benign and low-grade malignant lesions. World J Gastroenterol 2013; 19:1458-1465. [PMID: 23539545 PMCID: PMC3602506 DOI: 10.3748/wjg.v19.i9.1458] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 12/10/2012] [Accepted: 01/12/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the feasibility and safety of middle segmental pancreatectomy (MSP) compared with pancreaticoduodenectomy (PD) and extended distal pancreatectomy (EDP).
METHODS: We studied retrospectively 36 cases that underwent MSP, 44 patients who underwent PD, and 26 who underwent EDP with benign or low-grade malignant lesions in the mid-portion of the pancreas, between April 2003 and December 2009 in Ruijin Hospital. The perioperative outcomes and long-term outcomes of MSP were compared with those of EDP and PD. Perioperative outcomes included operative time, intraoperative hemorrhage, transfusion, pancreatic fistula, intra-abdominal abscess/infection, postoperative bleeding, reoperation, mortality, and postoperative hospital time. Long-term outcomes, including tumor recurrence, new-onset diabetes mellitus (DM), and pancreatic exocrine insufficiency, were evaluated.
RESULTS: Intraoperative hemorrhage was 316.1 ± 309.6, 852.2 ± 877.8 and 526.9 ± 414.5 mL for the MSP, PD and EDP groups, respectively (P < 0.05). The mean postoperative daily fasting blood glucose level was significantly lower in the MSP group than in the EDP group (6.3 ± 1.5 mmol/L vs 7.3 ± 1.5 mmol/L, P < 0.05). The rate of pancreatic fistula was higher in the MSP group than in the PD group (42% vs 20.5%, P = 0.039), all of the fistulas after MSP corresponded to grade A (9/15) or B (6/15) and were sealed following conservative treatment. There was no significant difference in the mean postoperative hospital stay between the MSP group and the other two groups. After a mean follow-up of 44 mo, no tumor recurrences were found, only one patient (2.8%) in the MSP group vs five (21.7%) in the EDP group developed new-onset insulin-dependent DM postoperatively (P = 0.029). Moreover, significantly fewer patients in the MSP group than in the PD (0% vs 33.3%, P < 0.001) and EDP (0% vs 21.7%, P = 0.007) required enzyme substitution.
CONCLUSION: MSP is a safe and organ-preserving option for benign or low-grade malignant lesions in the neck and proximal body of the pancreas.
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Dumitrascu T, Scarlat A, Ionescu M, Popescu I. Central pancreatectomy versus spleen-preserving distal pancreatectomy: a comparative analysis of early and late postoperative outcomes. Dig Surg 2012; 29:400-7. [PMID: 23128466 DOI: 10.1159/000343927] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/30/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIM The aim of the present study is to compare the postoperative and long-term outcomes of central pancreatectomy (CP) and spleen-preserving distal pancreatectomy (SPDP). METHODS Clinical, pathological and long-term data were compared between 22 patients who underwent CP and 25 patients who underwent SPDP (2002-2012). RESULTS The median length of resected pancreas was 8.5 cm in the SPDP group and 5 cm in the CP group (p < 0.001). The median estimated blood loss was significantly lower in the CP group (p = 0.019). Morbidity was 50% for CPs and 40% for SPDPs (p = 0.564). The rate of pancreatic fistulae was 36% for CPs and 40% for SPDPs (p = 0.530). The rate of new-onset diabetes was nil in the successful CP group and 16% in the SPDP group (p = 0.111). CONCLUSION Morbidity and pancreatic fistula rates are not higher after CP when compared to SPDP. The loss of normal pancreatic tissue is significantly lower for CP, and thus there is potentially better preservation of the pancreatic endocrine functions. CP should be considered only in selected cases when preservation of the pancreas is of utmost importance, especially for lesions situated at the level of the pancreatic neck.
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Affiliation(s)
- Traian Dumitrascu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania
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