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Safety and Feasibility of Single-incision Laparoscopic Distal Pancreatectomy. Surg Laparosc Endosc Percutan Tech 2022; 32:488-493. [PMID: 35583583 DOI: 10.1097/sle.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Comparative studies regarding single-incision laparoscopic distal pancreatectomy (SILS-DP) are limited. This study aimed to compare the short-term outcomes of SILS-DP with conventional laparoscopic DP (C-LDP) under strict indication criteria. MATERIALS AND METHODS We retrospectively reviewed the patient characteristics and surgical outcomes of those who underwent either SILS-DP or C-LDP at National Taiwan University (NTU) and C-LDP at Nara Medical University (NMU) between 2009 and 2019. SILS-DP was indicated for benign or low-grade malignant pancreatic tail tumors and was performed along with splenectomy. RESULTS We compared 12 cases of SILS-DP with 31 of C-LDP from NTU and 17 of C-LDP from NMU. Patients in the SILS-DP group had significantly less blood loss than the C-LDP group at NTU (P=0.028). Postoperative outcomes, including the postoperative hospital stay and clinically relevant pancreatic fistula, were not significantly different between the 2 groups. Although SILS-DP was performed by a surgeon who was well-experienced with laparoscopic surgeries, the first few cases had a larger amount of blood loss, longer operation time, and a higher rate of complications. Such unfavorable outcomes were likely to be resolved shortly. No reoperations and deaths were noted. CONCLUSION SILS-DP is feasible when performed by an experienced surgeon and in carefully selected patients.
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Gadiyaram S, Nachiappan M, Thota R. Considerations in laparoscopic resection of giant pancreatic cystic neoplasms. J Minim Access Surg 2022; 18:519-525. [PMID: 35046179 PMCID: PMC9632698 DOI: 10.4103/jmas.jmas_164_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Laparoscopic distal pancreatectomy (LDP) with (LDPS) or without splenectomy for cystic tumours in the body and tail has become the standard of care. Data on patients with large tumours of the body and tail of the pancreas are sparse. Patients and Methods: A retrospective analysis of a prospectively maintained database of patients who were managed with laparoscopic surgery for pancreatic cystic neoplasm since 2010 was done. Patients with cysts more than 8 cm were analysed. Clinical presentation, imaging, details of the surgical procedure and the outcomes were looked into. Results: Five patients of giant pancreatic cystic neoplasm (GPCN) were managed with LDPS. Four patients were female, mean age was 45 years (range 15–69 years). The mean cyst size was 11.2 cms (range 8–15 cm). The splenic vein was either stretched or thrombosed in all patients. Three patients had sinistral portal hypertension. All patients were operated with a modified five-port placement. None of the patients required conversion. Mean operative duration was 3½ h, blood loss was 80 ml approximately and none required a blood transfusion. One patient had a biochemical leak. All patients were discharged from the hospital by 3rd postoperative day. Drain removal was done before discharge except in the patient with biochemical leak (removed on day 6). On a median follow-up of 89 months (range 1–120 months), two patients developed diabetes. There has been no Overwhelming post-splenectomy infections (OPSI). Conclusion: Laparoscopic distal pancreatectomy is feasible in patients with GPCN and offers the all the short-term benefits, namely lesser pain, no wound infections, early return of bowel activity, early return to orals and early discharge and early return to work. Splenectomy was required in all patients because of splenic vein thrombosis and portal hypertension in three and for technical reasons in the rest.
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Yamada S, Fujii T, Sonohara F, Kawai M, Shibuya K, Matsumoto I, Fukuzawa K, Baba H, Aoki T, Unno M, Satoi S, Kishi Y, Hatano E, Uemura K, Horiguchi A, Sho M, Takeda Y, Shimokawa T, Kodera Y, Yamaue H. Safety of Combined Division vs Separate Division of the Splenic Vein in Patients Undergoing Distal Pancreatectomy: A Noninferiority Randomized Clinical Trial. JAMA Surg 2021; 156:418-428. [PMID: 33656542 PMCID: PMC7931136 DOI: 10.1001/jamasurg.2021.0108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Question In distal pancreatectomy, is combined division of the splenic vein safe compared with separate division of the splenic vein? Findings In this noninferiority randomized clinical trial, the proportion of grade B/C pancreatic fistula in the separate division group was 27.1% vs 28.6% in the combined division group, demonstrating noninferiority of the combined division of the splenic vein against separate division. Meaning The safety of combined division of the splenic vein in distal pancreatectomy was established, such that the approach could be recommended with more confidence. Importance In distal pancreatectomy (DP), the splenic vein is isolated from the pancreatic parenchyma prior to being ligated and divided to prevent intra-abdominal hemorrhage from the splenic vein stump with pancreatic fistula (PF). Conversely, dissecting the splenic vein with the pancreatic parenchyma is easy and time-saving. Objective To establish the safety of combined division of the splenic vein compared with separate division of the splenic vein. Design, Setting, and Participants This study was designed as a multicenter prospective randomized phase 3 trial. All results were analyzed using the modified intent-to-treat set. Patients undergoing DP for pancreatic body and tail tumors were eligible for inclusion. Patients were randomly assigned between August 10, 2016, and July 30, 2019. Interventions Patients were centrally randomized (1:1) to either separate division of the splenic vein or combined division of the splenic vein. Main Outcomes and Measures The primary end point was the incidence of grade B/C PF, and the incidence of intra-abdominal hemorrhage was included as one of the secondary end points. Results A total of 318 patients were randomly assigned, and 2 patients were excluded as ineligible. Of the 316 remaining patients, 150 (50.3%) were male. The modified intent-to-treat population constituted 159 patients (50.3%) in the separate division group and 157 patients (49.7%) in the combined division group. In the modified intent-to-treat set, the proportion of grade B/C PF in the separate division group was 27.1% (42 of 155) vs 28.6% (44 of 154) in the combined division group (adjusted odds ratio, 1.108; 95% CI, 0.847-1.225; P = .047), demonstrating noninferiority of the combined division of the splenic vein against separate division. The incidence of postoperative intra-abdominal hemorrhage in the 2 groups was identical at 1.3%. Conclusions and Relevance This study demonstrated noninferiority of the combined division of the splenic vein compared with separate division of the splenic vein regarding safety. Thus, isolating the splenic vein from the pancreatic parenchyma is deemed unnecessary. Trial Registration ClinicalTrials.gov Identifier: NCT02871804
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Affiliation(s)
- Suguru Yamada
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Tsutomu Fujii
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Sugitani, Toyama, Japan
| | - Fuminori Sonohara
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Manabu Kawai
- Second Department of Surgery, Wakayama Medical University, Kimiidera, Wakayama, Japan
| | - Kazuto Shibuya
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Sugitani, Toyama, Japan
| | - Ippei Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, Ono-higashi, Osaka-Sayama, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Science, Honjo, Chuo-ku, Kumamoto, Japan
| | - Takeshi Aoki
- Department of Gastroenterological and General Surgery, Showa University School of Medicine, Hatanodai, Shinagawa-ku, Tokyo, Japan
| | - Michiaki Unno
- Division of Hepato-Biliary Pancreatic Surgery, Tohoku University Graduate School of Medicine, Seiryo-cho, Aoba-ku, Sendai, Japan
| | - Sohei Satoi
- Department of Surgery, Kansai Medical University, Shinmachi, Hirakata, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, Namiki, Tokorozawa, Saitama, Japan
| | - Etsuro Hatano
- Department of Gastroenterological Surgery, Hyogo College of Medicine, Mukogawa, Nishinomiya, Hyogo, Japan
| | - Kenichiro Uemura
- Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Kasumi, Minami-ku, Hiroshima, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Otobashi, Nakagawa-ku, Nagoya, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University School of Medicine, Shijo-cho, Kashihara, Nara, Japan
| | - Yutaka Takeda
- Department of Surgery, Japan Organization of Occupational Health and Safety, Kansai Rosai Hospital, Inabaso, Amagasaki, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Kimiidera, Wakayama, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Kimiidera, Wakayama, Japan
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Manuel-Vázquez A, Oliver-Guillén JR, Latorre-Fragua R, Palomares Cano A, Serradilla Martín M, Ramia JM. The top 100. Review of the most cited articles on pancreas and laparoscopy. Cir Esp 2021; 99:124-131. [PMID: 32499052 DOI: 10.1016/j.ciresp.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 04/27/2020] [Accepted: 05/02/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The number of citations is considered as an indirect indicator of the merit of an article, journal or researcher, although it is not an infallible method to determine scientific quality. Our goal is to determine the characteristics of the articles most cited about pancreas and laparoscopy. METHODS We performed a search of all articles published in any journal about pancreas and laparoscopy until September 2019 and selected the 100 most cited papers. We recorded number of citations, journal, year of publication, quartil, impact factor, institution, country, authors type of paper, type of surgery, topic and area. RESULTS The top 100 citations account 10,970 citations in total. The journal with the most articles is Surgical Endoscopy and 2007 is the year with the highest number of articles in the top 100 citations. The percentage of publications from America and Europe are similar. Case series is the most frequently paper, outcomes/morbidity is the most frequently discussed topic, and distal pancreatectomy is the most frequently type of surgery. CONCLUSIONS This bibliometric study on pancreas and laparoscopy is conditioned by the time factor, since laparoscopy has arrived later at pancreatic surgery, probably due to the morbidity and mortality associated with pancreatic surgery and the need for a high specialization in this field. The literature is recent and scarce. More and better-quality studies are needed in this field.
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Affiliation(s)
- Alba Manuel-Vázquez
- Cirugía General y Digestiva, Hospital Universitario de Guadalajara, Guadalajara, España.
| | | | - Raquel Latorre-Fragua
- Cirugía General y Digestiva, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Ana Palomares Cano
- Cirugía General y Digestiva, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | - José Manuel Ramia
- Cirugía General y Digestiva, Hospital Universitario de Guadalajara, Guadalajara, España
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Tanaka K, Yamada S, Sonohara F, Takami H, Hayashi M, Kanda M, Kobayashi D, Tanaka C, Nakayama G, Koike M, Fujiwara M, Kodera Y. Pancreatic Fat and Body Composition Measurements by Computed Tomography are Associated with Pancreatic Fistula After Pancreatectomy. Ann Surg Oncol 2020; 28:530-538. [PMID: 32436185 DOI: 10.1245/s10434-020-08581-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Postoperative pancreatic fistula (POPF) is the most threatening complication after pancreatectomy. This study aimed to directly assess pancreatic fatty infiltration with preoperative computed tomography (CT) imaging and to investigate whether a preoperative analysis of patient variables, including CT characteristics and clinical factors, can predict POPF. METHODS We enrolled 150 consecutive patients who underwent curative pancreatectomy. Radiographic factors, including pancreatic fat volume, were measured using preoperative CT imaging and the predictive factors were explored using univariate and multivariate analyses. RESULTS POPF developed in 30 patients (20.0%). The ratio of pancreatic fat (RPF) ≥ 4.83% was associated with a risk of POPF, high body mass index (BMI), and obese body habitus. Patients with POPF were significantly more likely to have high BMI (≥ 25 kg/m2), obese body habitus, and an RPF ≥ 4.83% than patients without POPF. In the multivariate analysis, visceral fat area/skeletal muscle index (VFA/SMI) ≥ 1.94 (odds ratio [OR] 4.28, 95% confidence interval [CI] 1.43-12.9, p = 0.0095) was the sole independent predictive factor for POPF. For patients with a soft pancreas, VFA/SMI ≥ 1.94 (OR 5.67, 95% CI 2.05-15.7, p = 0.0008) was again the sole independent predictive factor for POPF. CONCLUSION Preoperative CT images can examine pancreatic fatty infiltration, and patients who had POPF were significantly associated with a high RPF. Among several parameters, VFA/SMI was the only independent predictive factor for clinically relevant POPF. Preoperative evaluation of these body composition variables and the pancreatic configuration could be useful for predicting POPF.
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Affiliation(s)
- Katsuhito Tanaka
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Suguru Yamada
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Fuminori Sonohara
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hideki Takami
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masamichi Hayashi
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Daisuke Kobayashi
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Chie Tanaka
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Goro Nakayama
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahiko Koike
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Michitaka Fujiwara
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Shibuya K, Jang JY, Satoi S, Sho M, Yamada S, Kawai M, Kim H, Kim SC, Heo JS, Yoon YS, Park JS, Hwang HK, Yoshioka I, Shimokawa T, Yamaue H, Fujii T. The efficacy of polyglycolic acid felt reinforcement in preventing postoperative pancreatic fistula after pancreaticojejunostomy in patients with main pancreatic duct less than 3 mm in diameter and soft pancreas undergoing pancreatoduodenectomy (PLANET-PJ trial): study protocol for a multicentre randomized phase III trial in Japan and Korea. Trials 2019; 20:490. [PMID: 31399139 PMCID: PMC6688253 DOI: 10.1186/s13063-019-3595-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 07/18/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Partial pancreatoduodenectomy is performed for malignant and benign diseases of the pancreatic head region. The procedure is considered highly difficult and highly invasive. Postoperative pancreatic fistula (POPF) is an important complication because of several consequent complications, including intraabdominal haemorrhage, often increasing hospital stays and surgical mortality. Although many kinds of pancreaticojejunostomy aimed at reducing POPF have been examined to date, the technique has not yet been standardized. We devised a new method using double-coated polyglycolic acid felt after pancreaticojejunostomy. The aim of the PLANET-PJ trial is to evaluate the superiority of polyglycolic acid felt reinforcement in preventing POPF after pancreaticojejunostomy in patients undergoing partial pancreatoduodenectomy to previous anastomosis methods. METHODS Patients diagnosed with pancreatic or periampullary lesions in whom it is judged that the main pancreatic duct diameter was 3 mm or less on the left side of the portal vein without pancreatic parenchymal atrophy due to obstructive pancreatitis are considered eligible for inclusion. This study is designed as a multicentre randomized phase III trial in Japan and the Republic of Korea. Eligible patients will be centrally randomized to either group A (polyglycolic acid felt reinforcement) or group B (control). In total, 514 patients will be randomized in 31 high-volume centres in Japan and Republic of Korea. The primary endpoint is the incidence of POPF (International Study Group of Pancreatic Surgery grade B/C). DISCUSSION The PLANET-PJ trial evaluates the efficacy of a new method using double-coated polyglycolic acid felt reinforcement for preventing POPF after pancreaticojejunostomy. This new method may reduce POPF. TRIAL REGISTRATION ClinicalTrials.gov, NCT03331718 . University Hospital Medical Information Network Clinical Trials Registry, UMIN000029647. Registered on 30 November 2017. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000033874.
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Affiliation(s)
- Kazuto Shibuya
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194 Japan
| | - Jin-Young Jang
- Department of Surgery, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sohei Satoi
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Suguru Yamada
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Manabu Kawai
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hongbeom Kim
- Department of Surgery, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Song Cheol Kim
- Department of Surgery, Asan Medical Centre, Seoul, Republic of Korea
| | - Jin Seok Heo
- Department of Surgery, Samsung Medical Centre, Seoul, Republic of Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Joon Seong Park
- Department of Surgery, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Ho Kyoung Hwang
- Department of Surgery, Severance Hospital, Seoul, Republic of Korea
| | - Isaku Yoshioka
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194 Japan
| | - Toshio Shimokawa
- Clinical Study Support Centre, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Tsutomu Fujii
- Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194 Japan
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