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Yin ZZ, Gao YX, Zhao ZM, Hu MG, Tang WB, Liu R. Robotic versus laparoscopic surgery for sporadic benign insulinoma: Short- and long-term outcomes. Hepatobiliary Pancreat Dis Int 2024; 23:399-405. [PMID: 37423832 DOI: 10.1016/j.hbpd.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Minimally invasive surgery is the optimal treatment for insulinoma. The present study aimed to compare short- and long-term outcomes of laparoscopic and robotic surgery for sporadic benign insulinoma. METHODS A retrospective analysis of patients who underwent laparoscopic or robotic surgery for insulinoma at our center between September 2007 and December 2019 was conducted. The demographic, perioperative and postoperative follow-up results were compared between the laparoscopic and robotic groups. RESULTS A total of 85 patients were enrolled, including 36 with laparoscopic approach and 49 with robotic approach. Enucleation was the preferred surgical procedure. Fifty-nine patients (69.4%) underwent enucleation; among them, 26 and 33 patients underwent laparoscopic and robotic surgery, respectively. Robotic enucleation had a lower conversion rate to laparotomy (0 vs. 19.2%, P = 0.013), shorter operative time (102.0 vs. 145.5 min, P = 0.008) and shorter postoperative hospital stay (6.0 vs. 8.5 d, P = 0.002) than laparoscopic enucleation. There were no differences between the groups in terms of intraoperative blood loss, the rates of postoperative pancreatic fistula and complications. After a median follow-up of 65 months, two patients in the laparoscopic group developed a functional recurrence and none of the patients in the robotic group had a recurrence. CONCLUSIONS Robotic enucleation can reduce the conversion rate to laparotomy and shorten operative time, which might lead to a reduction in postoperative hospital stay.
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Affiliation(s)
- Zhu-Zeng Yin
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yuan-Xing Gao
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhi-Ming Zhao
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Ming-Gen Hu
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Wen-Bo Tang
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Rong Liu
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; Institute of Hepatobiliary Surgery of Chinese PLA, Beijing 100853, China; Key Laboratory of Digital Hepatobiliary Surgery of Chinese PLA, Beijing 100853, China.
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2
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Patrone R, Mongardini FM, Conzo A, Cacciatore C, Cozzolino G, Catauro A, Lanza E, Izzo F, Belli A, Palaia R, Flagiello L, De Vita F, Docimo L, Conzo G. Pancreatic Neuroendocrine Tumors: What Is the Best Surgical Option? J Clin Med 2024; 13:3015. [PMID: 38792555 PMCID: PMC11121769 DOI: 10.3390/jcm13103015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Pancreatic neuroendocrine tumors (pNETs) represent a rare subset of pancreatic cancer. Functional tumors cause hormonal changes and clinical syndromes, while non-functional ones are often diagnosed late. Surgical management needs multidisciplinary planning, involving enucleation, distal pancreatectomy with or without spleen preservation, central pancreatectomy, pancreaticoduodenectomy or total pancreatectomy. Minimally invasive approaches have increased in the last decade compared to the open technique. The aim of this study was to analyze the current diagnostic and surgical trends for pNETs, to identify better interventions and their outcomes. Methods: The study adhered to the PRISMA guidelines, conducting a systematic review of the literature from May 2008 to March 2022 across multiple databases. Several combinations of keywords were used ("NET", "pancreatic", "surgery", "laparoscopic", "minimally invasive", "robotic", "enucleation", "parenchyma sparing") and relevant article references were manually checked. The manuscript quality was evaluated. Results: The study screened 3867 manuscripts and twelve studies were selected, primarily from Italy, the United States, and China. A total of 7767 surgically treated patients were collected from 160 included centers. The mean age was 56.3 y.o. Enucleation (EN) and distal pancreatectomy (DP) were the most commonly performed surgeries and represented 43.4% and 38.6% of the total interventions, respectively. Pancreatic fistulae, postoperative bleeding, re-operation, and follow-up were recorded and analyzed. Conclusions: Enucleation shows better postoperative outcomes and lower mortality rates compared to pancreaticoduodenectomy (PD) or distal pancreatectomy (DP), despite the similar risks of postoperative pancreatic fistulae (POPF). DP is preferred over enucleation for the pancreas body-tail, while laparoscopic enucleation is better for head pNETs.
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Affiliation(s)
- Renato Patrone
- Hepatobiliary Surgical Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy; (F.I.); (A.B.); (R.P.); (L.D.); (G.C.)
| | - Federico Maria Mongardini
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.M.M.); (A.C.); (C.C.); (G.C.); (A.C.); (E.L.); (L.F.)
| | - Alessandra Conzo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.M.M.); (A.C.); (C.C.); (G.C.); (A.C.); (E.L.); (L.F.)
| | - Chiara Cacciatore
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.M.M.); (A.C.); (C.C.); (G.C.); (A.C.); (E.L.); (L.F.)
| | - Giovanni Cozzolino
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.M.M.); (A.C.); (C.C.); (G.C.); (A.C.); (E.L.); (L.F.)
| | - Antonio Catauro
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.M.M.); (A.C.); (C.C.); (G.C.); (A.C.); (E.L.); (L.F.)
| | - Eduardo Lanza
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.M.M.); (A.C.); (C.C.); (G.C.); (A.C.); (E.L.); (L.F.)
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy; (F.I.); (A.B.); (R.P.); (L.D.); (G.C.)
| | - Andrea Belli
- Hepatobiliary Surgical Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy; (F.I.); (A.B.); (R.P.); (L.D.); (G.C.)
| | - Raffaele Palaia
- Hepatobiliary Surgical Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy; (F.I.); (A.B.); (R.P.); (L.D.); (G.C.)
| | - Luigi Flagiello
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.M.M.); (A.C.); (C.C.); (G.C.); (A.C.); (E.L.); (L.F.)
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Internal and Experimental Medicine ‘F. Magrassi’, Università della Campania ‘Luigi Vanvitelli’, 80138 Naples, Italy;
| | - Ludovico Docimo
- Hepatobiliary Surgical Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy; (F.I.); (A.B.); (R.P.); (L.D.); (G.C.)
| | - Giovanni Conzo
- Hepatobiliary Surgical Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy; (F.I.); (A.B.); (R.P.); (L.D.); (G.C.)
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Uchida Y, Takahara T, Nishimura A, Mii S, Mizumoto T, Iwama H, Kojima M, Uyama I, Suda K. Robotic pancreatic tumor enucleation by the double bipolar technique using the da Vinci SP system: An initial case report with a technical detail. Asian J Endosc Surg 2024; 17:e13271. [PMID: 38081193 DOI: 10.1111/ases.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 01/13/2024]
Abstract
Pancreatic tumor enucleation is a procedure that can preserve pancreatic function and is sometimes performed using a minimally invasive approach. Recently, a single-port robotic platform called da Vinci SP has been developed. However, the technical details of pancreatic tumor enucleation using da Vinci SP have not been reported to date. We report a male patient in his 70s who underwent robotic SP pancreatic tumor enucleation for a pancreatic neuroendocrine tumor. The dissection between the tumor and pancreatic parenchyma was performed using the double bipolar technique. The operative time was 139 min, and the estimated blood loss was 4 mL. The patient had an uneventful recovery and was discharged on the sixth day after the surgery. Robotic SP pancreatic tumor enucleation appears to be a feasible procedure with lower invasiveness and better cosmesis.
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Affiliation(s)
- Yuichiro Uchida
- Department of Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Takeshi Takahara
- Department of Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Akihiro Nishimura
- Department of Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Satoshi Mii
- Department of Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Takuya Mizumoto
- Department of Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Hideaki Iwama
- Department of Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Masayuki Kojima
- Department of Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Ichiro Uyama
- Department of Advanced Robotics and Laparoscopic Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, Toyoake, Aichi, Japan
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Huang Z, He A, Wang J, Lu H, Rao S, Huang Y, Feng Q. Minimally invasive enucleation versus open enucleation for benign or low-grade malignant pancreatic neoplasms: Effects on clinical outcomes and quality of life. J Minim Access Surg 2023; 19:419-426. [PMID: 37470631 PMCID: PMC10449040 DOI: 10.4103/jmas.jmas_182_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 04/08/2023] [Accepted: 05/03/2023] [Indexed: 06/27/2023] Open
Abstract
Introduction The efficacy and safety of minimally invasive pancreatic enucleation (PE) have rarely been investigated. This study aimed to compare the perioperative and long-term outcomes of minimally invasive enucleation (MIEn) with those of open enucleation (OEn) for benign/low-grade malignant pancreatic neoplasms. Patients and Methods Data collected from patients who underwent PE between January 2011 and June 2020 at our centre were analysed. Results Forty-two patients who underwent MIEn (10 - robot-assisted and 32 - laparoscopic) and 47 who underwent OEn were included in this study. Compared with the OEn group, the MIEn group showed shorter operation time (147.6 ± 71.3 min vs. 183.1 ± 64.3 min), shorter post-operative hospital stay (11.5 ± 3.9 days vs. 13.4 ± 4.2 days), shorter off-bed activity time (2.9 ± 0.9 days vs. 3.7 ± 1.0 days) and lower estimated blood loss (EBL) (118.5 ± 59.2 mL vs. 153.1 ± 85.0 mL). Overall complication rate (47.6% vs. 55.3%), overall post-operative pancreatic fistula (POPF) rate (40.5% vs. 44.7%) and Grade B + C POPF rate (11.9% vs. 19.1%) were similar in both the groups. For neoplasms located in the proximal pancreas, MIEn showed more favourable perioperative outcomes than OEn. Unlike MIEn for superficial neoplasms, MIEn for neoplasms deeply embedded in the pancreas resulted in a longer operative time and tended to increase EBL and the incidence of complications and POPF. During the follow-up period, no significant differences were observed between these two groups in terms of pancreatic function or quality of life. Conclusions Compared to OEn, MIEn is effective and safe for patients with benign or low-grade malignant pancreatic neoplasms. However, MIEn for embedded pancreatic neoplasms is recommended only in experienced centres because of the high rates of complications and POPF.
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Affiliation(s)
- Zhihao Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Aoxiao He
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiakun Wang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hongcheng Lu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shanshan Rao
- Department of Nursing, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qian Feng
- Department of Emergency, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Bencini L, Urciuoli I, Moraldi L. Robot-Assisted Pancreatic Surgery: Safety and Feasibility. THE HIGH-RISK SURGICAL PATIENT 2023:453-463. [DOI: 10.1007/978-3-031-17273-1_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2024]
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Bahra M, Ossami Saidy RR. Current status of robotic surgery for hepato-pancreato-biliary malignancies. Expert Rev Anticancer Ther 2022; 22:939-946. [PMID: 35863758 DOI: 10.1080/14737140.2022.2105211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Robotic surgery is an emerging aspect of gastrointestinal surgery. Hepato-pancreato-biliary surgery is currently being explored for a broad spectrum of indications, entities, and postoperative outcomes. Noninferiority and financial aspects are the focus of studies. In this review, the impact on oncological therapies is assessed. AREAS COVERED An extensive literature review was conducted, and relevant studies and articles and reviews for robotic surgery in the field of hepato-pancreato-biliary surgery were examined. Special attention was given to the oncological aspects of robotic surgery and its possible impact on the therapy of malignant neoplasms. EXPERT OPINION Robotic-assisted surgery for oncological indications is promising, in part, an established technique that has already shown its advantages in the last decade, although high-quality studies are missing. Upcoming experience must consider the oncological benefit and putative new indications in a rapidly changing field of anti-neoplastic regimens. Also, robotic surgery may possess the ability to accelerate digitalization and AI-based augmentation in this context.
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Affiliation(s)
- Marcus Bahra
- Krankenhaus Waldfriede, Akademisches Lehrkrankenhaus der Charité, Zentrum für Onkologische Oberbauchchirurgie und Robotik, Argentinische Allee 40, 14163 Berlin
| | - Ramin Raul Ossami Saidy
- Krankenhaus Waldfriede, Akademisches Lehrkrankenhaus der Charité, Zentrum für Onkologische Oberbauchchirurgie und Robotik, Argentinische Allee 40, 14163 Berlin
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Pergolini I, Friess H, Demir IE. Resektionsstrategien beim BD-IPMN - Enukleation oder onkologische Resektion? Zentralbl Chir 2022; 147:155-159. [DOI: 10.1055/a-1759-4492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Hintergrund Das maligne Potenzial und die chirurgische Behandlung intraduktaler papillärer muzinöser Neoplasien der Seitengänge der Bauchspeicheldrüse (BD-IPMNs) bleiben umstritten.
Die Enukleation (EN) als parenchymsparende Resektion des Pankreas kann eine wertvolle Alternative zu Standardresektionen (SR), z. B. Whipple oder distale Pankreatektomie, für die Behandlung
von BD-IPMNs darstellen, ihre Rolle ist jedoch noch unzureichend definiert. Ziel dieser Übersichtsarbeit ist es, Indikationen und postoperative Ergebnisse nach Pankreas-Enukleation im
Vergleich zur Standardresektion (SR) zu vergleichen.
Methoden Es wurde eine selektive Literaturrecherche durchgeführt. Die postoperativen Kurz- und Langzeitergebnisse beider Operationsverfahren wurden ausgewertet.
Ergebnisse Die EN ist im Vergleich zur SR mit einer kürzeren Operationszeit und einem geringeren Blutverlust verbunden. Die chirurgische Gesamtmorbidität unterscheidet sich nicht
zwischen den beiden Verfahren. Obwohl die EN weniger invasiv ist, stellt die Entwicklung einer Pankreasfistel die häufigste Komplikation nach EN dar, und in mehreren Studien wird über eine
höhere Rate an Pankreasfisteln nach EN als nach SR berichtet. Die Unterschiede, bezogen auf die Pankreasfistel, werden zwischen den beiden Verfahren in High-Volume-Zentren abgemildert. Die
EN ermöglicht im Vergleich zur SR öfter den Erhalt der exokrinen und endokrinen Funktion der Bauchspeicheldrüse, dies ist der wichtigste Vorteil dieses Verfahrens.
Schlussfolgerungen Die EN scheint eine sichere und wirksame Alternative in der Behandlung der Seitengang-IPMN mit geringem Risiko zu sein, die den Erhalt der endokrinen und exokrinen
Funktion ermöglicht. Außerdem sind die postoperativen Komplikationen und Rezidivraten nach EN vergleichbar mit den wesentlich umfangreicheren chirurgischen Verfahren. Die EN der
Bauchspeicheldrüse sollte jedoch von erfahrenen Chirurgen durchgeführt werden. Da es sich um ein nicht onkologisches Verfahren handelt, muss die Auswahl der Patienten sehr genau erfolgen,
was die Bedeutung der Behandlung in Einrichtungen mit hohem Patientenaufkommen unterstreicht.
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Affiliation(s)
- Ilaria Pergolini
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - Helmut Friess
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - Ihsan Ekin Demir
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
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Shen X, Yang X. Comparison of Outcomes of Enucleation vs. Standard Surgical Resection for Pancreatic Neoplasms: A Systematic Review and Meta-Analysis. Front Surg 2022; 8:744316. [PMID: 35155544 PMCID: PMC8825491 DOI: 10.3389/fsurg.2021.744316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/09/2021] [Indexed: 01/04/2023] Open
Abstract
Background With advancement in health technology, the detection rate of pancreatic neoplasms is increasing. Tissue sparing surgery (enucleation) as well as standard surgical resection are two commonly used modalities of management. There are studies comparing clinical outcomes between these two modalities; however, there is lack of studies that systematically pool the available findings to present conclusive and reliable evidence. Methods A systematic search was conducted using the PubMed, Scopus, and Google Scholar databases. Studies that were randomised controlled trials or cohort based or analysed retrospective data were considered for inclusion. Studies should have been done in adult patients with pancreatic neoplasms and should have examined the outcomes of interest by the two management modalities i.e., enucleation and standard surgical resection. Statistical analysis was performed using STATA software. Results A total of 20 studies were included in the meta-analysis. The operation time (in minutes) (WMD −78.20; 95% CI: −89.47, −66.93) and blood loss (in ml) (WMD −204.30; 95% CI: −281.70, −126.90) for enucleation was significantly lesser than standard surgical resection. The risk of endocrine (RR 0.32; 95% CI: 0.18, 0.56) and exocrine insufficiency (RR 0.16; 95% CI: 0.07, 0.34) was lower whereas the risk of post-operative pancreatic fistula (RR 1.46; 95% CI: 1.22, 1.75) was higher in enucleation, compared to standard surgical resection group. There were no differences in the risk of reoperation, readmission, recurrence, mortality within 90 days and 5-years overall mortality between the two groups. Conclusions Enucleation, compared to standard surgical resection, was associated with better clinical outcomes and therefore, might be considered for selected pancreatic neoplasms. There is a need for randomised controlled trials to document the efficacy of these two management techniques.
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Segaran N, Devine C, Wang M, Ganeshan D. Current update on imaging for pancreatic neuroendocrine neoplasms. World J Clin Oncol 2021; 12:897-911. [PMID: 34733612 PMCID: PMC8546658 DOI: 10.5306/wjco.v12.i10.897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/21/2021] [Accepted: 08/27/2021] [Indexed: 02/06/2023] Open
Abstract
Pancreatic neuroendocrine neoplasms (panNEN) are a heterogeneous group of tumors with differing pathological, genetic, and clinical features. Based on clinical findings, they may be categorized into functioning and nonfunctioning tumors. Adoption of the 2017 World Health Organization classification system, particularly its differentiation between grade 3, well-differentiated pancreatic neuroendocrine tumors (panNET) and grade 3, poorly-differentiated pancreatic neuroendocrine carcinomas (panNEC) has emphasized the role imaging plays in characterizing these lesions. Endoscopic ultrasound can help obtain biopsy specimen and assess tumor margins and local spread. Enhancement patterns on computed tomography (CT) and magnetic resonance imaging (MRI) may be used to classify panNEN. Contrast enhanced MRI and diffusion-weighted imaging have been reported to be useful for characterization of panNEN and quantifying metastatic burden. Current and emerging radiotracers have broadened the utility of functional imaging in evaluating panNEN. Fluorine-18 fluorodeoxyglucose positron emission tomography (PET)/CT and somatostatin receptor imaging such as Gallium-68 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid–octreotate PET/CT may be useful for improved identification of panNEN in comparison to anatomic modalities. These new techniques can also play a direct role in optimizing the selection of treatment for individuals and predicting tumor response based on somatostatin receptor expression. In addition, emerging methods of radiomics such as texture analysis may be a potential tool for staging and outcome prediction in panNEN, however further investigation is required before clinical implementation.
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Affiliation(s)
- Nicole Segaran
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85259, United States
| | - Catherine Devine
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Mindy Wang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Dhakshinamoorthy Ganeshan
- Department of Diagnostic Radiology, Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
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Naples R, Thomas JD, Orabi DA, Reynolds JP, Robertson S, Siperstein AE, Walsh RM, Simon R, Shin JJ, Jin J, Krishnamurthy VD, Berber E. A critical analysis of laparoscopic and open approaches to sporadic pancreatic insulinoma resection in the modern era. Am J Surg 2021; 223:912-917. [PMID: 34702489 DOI: 10.1016/j.amjsurg.2021.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND A single center experience with sporadic pancreatic insulinoma was analyzed to develop an algorithm for modern surgical management. METHODS Thirty-four patients undergoing surgery from 2001 to 2019 were reviewed. RESULTS The majority underwent enucleation (10 laparoscopic, 15 open). Laparoscopy was performed in 22 patients with conversion to open in 11, mostly related to the proximity of the tumor to the pancreatic duct (n = 4). Tumors on the anterior and posterior surface of the pancreas in all anatomic locations were completed with laparoscopic enucleation. Overall, the clinically-relevant postoperative pancreatic fistula (CR-POPF) rate was 21%, with no difference between laparoscopic versus open enucleation (10% vs 20%, p = 0.50) or enucleation versus resection (16% vs 33%, p = 0.27). Laparoscopic enucleation had shorter median hospital length of stay (LOS) compared with open (4 vs 7 days, p = 0.02). CONCLUSIONS Laparoscopic enucleation does not increase the CR-POPF risk and provides an advantage with a shorter hospital LOS in select patients. Tumor location and relationship to the pancreatic duct guide surgical decision-making. These findings highlight tumor-specific criteria that would benefit from a minimally invasive approach.
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Affiliation(s)
- Robert Naples
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jonah D Thomas
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Danny A Orabi
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Scott Robertson
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | | | - R Matthew Walsh
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert Simon
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Joyce J Shin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Judy Jin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA.
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Qiu L, Trout AT, Ayyala RS, Szabo S, Nathan JD, Geller JI, Dillman JR. Pancreatic Masses in Children and Young Adults: Multimodality Review with Pathologic Correlation. Radiographics 2021; 41:1766-1784. [PMID: 34597223 DOI: 10.1148/rg.2021210008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Masses and masslike lesions of the pancreas are uncommon in the pediatric population. However, owing to overlapping clinical and imaging features, it can be challenging to differentiate the various causes of pediatric pancreatic masses at initial patient presentation. Clinical data such as patient age, signs and symptoms at presentation, laboratory test results, and potential underlying cancer predisposition syndrome can be helpful when formulating a differential diagnosis. US may be the first imaging study to depict a pancreatic mass in a child, as this examination is frequently performed in children with nonspecific abdominal signs and symptoms because of its wide availability and relatively low cost and the lack of a need for sedation or anesthesia. CT or MRI is typically required for more thorough characterization of the mass and surgical planning. Complete characterization of pancreatic masses includes assessment of vascular involvement, local invasion, and extrapancreatic spread of tumor. The authors provide an up-to-date comprehensive review of the clinical manifestations, histopathologic features, and imaging findings of primary and secondary tumors of the pancreas in children and young adults. Advances in imaging, current prognostic information, and treatment paradigms also are highlighted. Finally, nontumorous masslike lesions of the pediatric pancreas, including vascular malformations, cystic disorders (eg, von Hippel-Lindau syndrome, cystic fibrosis), intrapancreatic accessory spleen, and autoimmune pancreatitis, are discussed. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Lisa Qiu
- From the Department of Radiology (L.Q., A.T.T., R.S.A., J.R.D.), Department of Pathology (S.S.), Division of Pediatric General and Thoracic Surgery (J.D.N.), and Division of Oncology (J.I.G.), Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH 45229; and Departments of Radiology (A.T.T., R.S.A., J.R.D.), Pediatrics (A.T.T., J.I.G.), Pathology (S.S.), and Surgery (J.D.N.), University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Andrew T Trout
- From the Department of Radiology (L.Q., A.T.T., R.S.A., J.R.D.), Department of Pathology (S.S.), Division of Pediatric General and Thoracic Surgery (J.D.N.), and Division of Oncology (J.I.G.), Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH 45229; and Departments of Radiology (A.T.T., R.S.A., J.R.D.), Pediatrics (A.T.T., J.I.G.), Pathology (S.S.), and Surgery (J.D.N.), University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Rama S Ayyala
- From the Department of Radiology (L.Q., A.T.T., R.S.A., J.R.D.), Department of Pathology (S.S.), Division of Pediatric General and Thoracic Surgery (J.D.N.), and Division of Oncology (J.I.G.), Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH 45229; and Departments of Radiology (A.T.T., R.S.A., J.R.D.), Pediatrics (A.T.T., J.I.G.), Pathology (S.S.), and Surgery (J.D.N.), University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sara Szabo
- From the Department of Radiology (L.Q., A.T.T., R.S.A., J.R.D.), Department of Pathology (S.S.), Division of Pediatric General and Thoracic Surgery (J.D.N.), and Division of Oncology (J.I.G.), Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH 45229; and Departments of Radiology (A.T.T., R.S.A., J.R.D.), Pediatrics (A.T.T., J.I.G.), Pathology (S.S.), and Surgery (J.D.N.), University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jaimie D Nathan
- From the Department of Radiology (L.Q., A.T.T., R.S.A., J.R.D.), Department of Pathology (S.S.), Division of Pediatric General and Thoracic Surgery (J.D.N.), and Division of Oncology (J.I.G.), Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH 45229; and Departments of Radiology (A.T.T., R.S.A., J.R.D.), Pediatrics (A.T.T., J.I.G.), Pathology (S.S.), and Surgery (J.D.N.), University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - James I Geller
- From the Department of Radiology (L.Q., A.T.T., R.S.A., J.R.D.), Department of Pathology (S.S.), Division of Pediatric General and Thoracic Surgery (J.D.N.), and Division of Oncology (J.I.G.), Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH 45229; and Departments of Radiology (A.T.T., R.S.A., J.R.D.), Pediatrics (A.T.T., J.I.G.), Pathology (S.S.), and Surgery (J.D.N.), University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jonathan R Dillman
- From the Department of Radiology (L.Q., A.T.T., R.S.A., J.R.D.), Department of Pathology (S.S.), Division of Pediatric General and Thoracic Surgery (J.D.N.), and Division of Oncology (J.I.G.), Cincinnati Children's Hospital Medical Center, MLC 5031, 3333 Burnet Ave, Cincinnati, OH 45229; and Departments of Radiology (A.T.T., R.S.A., J.R.D.), Pediatrics (A.T.T., J.I.G.), Pathology (S.S.), and Surgery (J.D.N.), University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, Ohio
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12
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Schulte Am Esch J, Krüger M, Barthlen W, Förster C, Mohnike K, Empting S, Benhidjeb T, Vossschulte H. Technical aspects of paediatric robotic pancreatic enucleation based on a case of an insulinoma. Int J Med Robot 2021; 17:e2317. [PMID: 34297475 DOI: 10.1002/rcs.2317] [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: 05/30/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Insulinomas are rare insulin-producing pancreatic neuroendocrine tumours leading to severe episodes of hypoglycaemia. Surgery is the predominant curative therapy. METHODS We report here the first paediatric case of an insulinoma of the pancreatic body resected completely robotically under ultrasound guidance in a 10-year-old male with multiple endocrine neoplasia type 1. The port set-up was adapted for the narrowed dimensions of the paediatric peritoneal space. We comment on technical key steps for the organ-preserving procedure that was performed in close proximity to critical anatomic structures, with supporting video. Preoperative diagnostics, including endoscopic ultrasound, to determine surgical management are highlighted. RESULTS Following an uneventful post-operative course, the boy was discharged on day 11 with normalised glucose-metabolism. A pseudocyst developing after 4 weeks was treated with endoscopic stenting. CONCLUSIONS The applicability of a robotic surgical system in limited space conditions such as found in the paediatric abdominal cavity is demonstrated here for pancreatic surgery.
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Affiliation(s)
- Jan Schulte Am Esch
- Department of General and Visceral Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Bielefeld, Germany
| | - Martin Krüger
- Department of Internal Medicine and Gastroenterology, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Bielefeld, Germany
| | - Winfried Barthlen
- Department of Pediatric Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Bielefeld, Germany
| | - Christine Förster
- Institute of Pathology, KRH Hospital Nordstadt, affiliated with the University Hospital of the University of Bielefeld, Campus Bielefeld-Bethel, Hannover, Germany
| | | | - Susann Empting
- Department of Pediatrics, University Hospital Magdeburg, Magdeburg, Germany
| | - Tahar Benhidjeb
- Department of General and Visceral Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Bielefeld, Germany
| | - Hendrik Vossschulte
- Department of Pediatric Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Bielefeld, Germany
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13
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Chin KM, Goh BKP. Robotic enucleation of a pancreatic uncinate neuroendocrine tumor - a unique parenchyma-saving strategy for uncinate tumors. Ann Hepatobiliary Pancreat Surg 2020; 24:97-103. [PMID: 32181437 PMCID: PMC7061044 DOI: 10.14701/ahbps.2020.24.1.97] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/28/2019] [Accepted: 07/28/2019] [Indexed: 12/31/2022] Open
Abstract
Pancreatic neuroendocrine tumors (PNET) comprise up to 10% of all pancreatic solid tumors. There has been much interest in recent years with regards to the role of limited resection and enucleation procedures for this entity. There is no clear guideline today on the optimal type choice of surgery for this condition, with even fewer reporting on the use of a robotic approach for pancreatic uncinate lesions. We describe a case report of a 54-year-old lady who underwent successful robotic enucleation of pancreatic uncinate neuroendocrine tumor. This patient's recovery was complicated by pancreatitis and a peripancreatic collection, both of which resolved without surgical re-intervention. A literature review was performed with regards to current guidelines on management of PNETs, comparisons between demolitive and parenchymal-preserving procedures, and recent developments in the laparoscopic and robotic approaches for this condition. There is no clear guideline on the optimal type and approach (open vs. laparoscopic vs. robotic) to the surgical management of PNET. We document in this case report a novel approach of robotic enucleation of pancreatic uncinate process NET, that could be considered as an alternative to open/laparoscopic demolitive procedures for small uncinate tumors.
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Affiliation(s)
- Ken Min Chin
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.,Duke-National University of Singapore (NUS) Medical School, Singapore
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14
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Jeune F, Taibi A, Gaujoux S. Update on the Surgical Treatment of Pancreatic Neuroendocrine Tumors. Scand J Surg 2020; 109:42-52. [PMID: 31975647 DOI: 10.1177/1457496919900417] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Pancreatic neuroendocrine tumors (PNET) arise from uncontrolled proliferation of neuroendocrine cell and further genetic alterations that may induce hormone secretion such as glucagon/insulin/gastrin/VIP. Their incidence is rapidelly growing, especially because of the frequent incidental diagnosis of small asymptomatic non-functionnal neuroendocrine tumors with the widespread use of cross-sectional imaging. The vast majority of pancreatic neuroendocrine tumors are sporadic but up to 5%-10% of them arise from genetic syndromes, the main one being Multiple Endocrine Neopalsm type 1 (MEN1). Appropriate management of patients with PNET is a complex challenge for surgeons, and require extensive medical collaboration. This review aims to summarize major and recent updates regarding the medico-surgical management of PNETs. MATERIAL AND METHODS Review of pertinent English language literature. RESULTS This article provides a concise summary of the clinical presentation, diagnosis, surgical management, alternative treatments and follow up of PNETs. CONCLUSION PNET are a rare, heterogeneous group of neoplasms with a generally favorable prognosis at least compared to pancreatic adenocarcinoma. Surgical resection is the cornerstone of their management, particularly for localized disease, and should always be discussed in multidisciplinary tumor board.
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Affiliation(s)
- F Jeune
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Pitié Salpêtrière Hospital, AP-HP-Pierre and Marie Curie University, Paris VI, France
| | - A Taibi
- Department of Digestive and Endocrine surgery, Dupuytren University Hospital, Limoges, France
| | - S Gaujoux
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital AP-HP, Paris, France.,Faculté de Médecine Paris Descartes, Université Paris Descartes, Université Sorbonne Paris Cité, Paris, France
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15
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The current surgical treatment of pancreatic neuroendocrine neoplasms in China: a national wide cross-sectional study. JOURNAL OF PANCREATOLOGY 2019. [DOI: 10.1097/jp9.0000000000000019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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16
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Lefor AK. Robotic and laparoscopic surgery of the pancreas: an historical review. BMC Biomed Eng 2019; 1:2. [PMID: 32903347 PMCID: PMC7412643 DOI: 10.1186/s42490-019-0001-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022] Open
Abstract
Surgery of the pancreas is a relatively new field, with operative series appearing only in the last 50 years. Surgery of the pancreas is technically challenging. The entire field of general surgery changed radically in 1987 with the introduction of the laparoscopic cholecystectomy. Minimally Invasive surgical techniques rapidly became utilized worldwide for gallbladder surgery and were then adapted to other abdominal operations. These techniques are used regularly for surgery of the pancreas including distal pancreatectomy and pancreatoduodenectomy. The progression from open surgery to laparoscopy to robotic surgery has occurred for many operations including adrenalectomy, thyroidectomy, colon resection, prostatectomy, gastrectomy and others. Data to show a benefit to the patient are scarce for robotic surgery, although both laparoscopic and robotic surgery of the pancreas have been shown not to be inferior with regard to major operative and oncologic outcomes. While there were serious concerns when laparoscopy was first used in patients with malignancies, robotic surgery has been used in many benign and malignant conditions with no obvious deterioration of outcomes. Robotic surgery for malignancies of the pancreas is well accepted and expanding to more centers. The importance of centers of excellence, surgeon experience supported by a codified mastery-based training program and international registries is widely accepted. Robotic pancreatic surgery is associated with slightly decreased blood loss and decreased length of stay compared to open surgery. Major oncologic outcomes appear to have been preserved, with some studies showing higher rates of R0 resection and tumor-free margins. Patients with lesions of the pancreas should find a surgeon they trust and do not need to be concerned with the operative approach used for their resection. The step-wise approach that has characterized the growth in robotic surgery of the pancreas, in contradistinction to the frenzy that accompanied the introduction of laparoscopic cholecystectomy, has allowed the identification of areas for improvement, many of which lie at the junction of engineering and medical practice. Refinements in robotic surgery depend on a partnership between engineers and clinicians.
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Affiliation(s)
- Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi Japan
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17
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Bartolini I, Bencini L, Risaliti M, Ringressi MN, Moraldi L, Taddei A. Current Management of Pancreatic Neuroendocrine Tumors: From Demolitive Surgery to Observation. Gastroenterol Res Pract 2018; 2018:9647247. [PMID: 30140282 PMCID: PMC6081603 DOI: 10.1155/2018/9647247] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/29/2018] [Accepted: 07/04/2018] [Indexed: 02/07/2023] Open
Abstract
Incidental diagnosis of pancreatic neuroendocrine tumors (PanNETs) greatly increased in the last years. In particular, more frequent diagnosis of small PanNETs leads to many challenging clinical decisions. These tumors are mostly indolent, although a percentage (up to 39%) may reveal an aggressive behaviour despite the small size. Therefore, there is still no unanimity about the best management of tumor smaller than 2 cm. The risks of under/overtreatment should be carefully evaluated with the patient and balanced with the potential morbidities related to surgery. The importance of the Ki-67 index as a prognostic factor is still debated as well. Whenever technically feasible, parenchyma-sparing surgeries lead to the best chance of organ preservation. Lymphadenectomy seems to be another important prognostic issue and, according to recent findings, should be performed in noninsulinoma patients. In the case of enucleation of the lesion, a lymph nodal sampling should always be considered. The relatively recent introduction of minimally invasive techniques (robotic) is a valuable option to deal with these tumors. The current management of PanNETs is analysed throughout the many available published guidelines and evidences with the aim of helping clinicians in the difficult decision-making process.
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Affiliation(s)
- Ilenia Bartolini
- Department of Surgery and Translational Medicine, AOU Careggi, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Lapo Bencini
- Department of Oncology, AOU Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Matteo Risaliti
- Department of Surgery and Translational Medicine, AOU Careggi, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Maria Novella Ringressi
- Department of Surgery and Translational Medicine, AOU Careggi, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Luca Moraldi
- Department of Oncology, AOU Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Antonio Taddei
- Department of Surgery and Translational Medicine, AOU Careggi, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
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18
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Liang M, Jiang J, Dai H, Hong X, Han X, Cong L, Tong A, Li F, Luo Y, Liu W, Zhou L, Di W, Wu W, Zhao Y. Robotic enucleation for pediatric insulinoma with MEN1 syndrome: a case report and literature review. BMC Surg 2018; 18:44. [PMID: 29921249 PMCID: PMC6009035 DOI: 10.1186/s12893-018-0376-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/11/2018] [Indexed: 01/20/2023] Open
Abstract
Background A patient with a rare pediatric insulinoma and MEN1 syndrome was treated by robotic enucleation surgery. Case presentation We present a case of a 9-year-old girl presenting with repeated loss of consciousness, concomitant with a pale face, palpitations, and convulsions, which had persisted for 2 years and had been aggravated during the previous 2 months. She was previously misdiagnosed with epilepsy in another hospital. We further examined her while she was hospitalized. By combining her medical history and imaging examination and lab test results, a diagnosis of insulinoma was confirmed. Sanger-directed sequencing on a peripheral blood sample revealed an MEN1 gene mutation, indicating pediatric insulinoma with MEN1 syndrome. The patient underwent minimally invasive insulinoma enucleation surgery under the Da Vinci robot-assisted system with intraoperative ultrasound (IOUS) connected. The surgery was successfully completed within 65 min, and the girl recovered well postoperatively and no longer experienced symptoms of hypoglycemia. Conclusion This is the first report of a case of pediatric insulinoma treated using robotic enucleation. This experience demonstrates the feasibility and safety of combining robotic surgery with the enucleation procedure as an excellent strategy for pediatric insulinoma.
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Affiliation(s)
- Mei Liang
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jialin Jiang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Hongmei Dai
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xiafei Hong
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xianlin Han
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Lin Cong
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Anli Tong
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Fang Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Yaping Luo
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Weinan Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Liangrui Zhou
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Wenyu Di
- Department of Pathology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Wenming Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
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