Central Pancreatectomy for Central Pancreatic Lesions: A Single-Institution Experience

Central Pancreatectomy - A Novel Surgical Technique Single Institution Experience

Aims

Children evaluated for abdominal pain are increasingly recognized to have pancreatic lesions by imaging modalities. Malignant lesions of the pancreas have also been diagnosed at regular intervals, the most common being solid cystic pseudopapillary neoplasm (SPT) - Borderline (uncertain malignant potential). Surgical resection of this tumor should provide adequate tumor free margins and also should preserve pancreatic tissue. Radical resection of the pancreas will lead to pancreatic insufficiency. Herein, we describe the technique of central pancreatectomy wherein tumor excision gives adequate clearance but preserves the pancreatic tissue, thereby reducing significant morbidity.

Materials and Methods

Three children ages ranging between 11 to 12 years diagnosed to have SPT were included in the study.

Results

All children underwent successful central pancreatectomy and had an uneventful post operative recovery.

Conclusion

Central pancreatectomy offers a good volume of remanant pancreas preserving near normal pancreatic function making it an ideal procedure for select cases.

Nomogram predicts CR-POPF in open central pancreatectomy patients with benign or low-grade malignant pancreatic neoplasms

Introduction

Central pancreatectomy (CP) is a standard surgical procedure for benign and low-grade malignant pancreatic neoplasms in the body and neck of the pancreas. Higher incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) after CP than after pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) has been reported, but no nomogram for prediction of CR-POPF after open CP has been previously established.

Methods

Patients undergoing open CP for benign or low-grade malignant pancreatic neoplasms in the department of Hepatobiliary and Pancreatic (HBP) surgery of Shanghai Changhai Hospital affiliated to Naval Medical University between January 01, 2009 and December 31,2020 were enrolled. Pre-, intra- and post-operative parameters were analyzed retrospectively.

Results

A total of 194 patients, including 60 men and 134 women, were enrolled with median age of 52 years (21~85 years). 84 patients (43.3%) were overweight (BMI>23.0 Kg/m2) and 14 (7.2%) were obese (BMI>28.0 Kg/m2). Pathological diagnoses ranged from serous cystic neoplasm (32.5%), solid pseudopapillary neoplasm (22.2%), pancreatic neuroendocrine tumor (20.1%), intraductal papillary mucinous neoplasm (18.0%) to mucinous cystic neoplasm (5.2%). All patients had soft pancreatic texture. Main pancreatic duct diameters were ≤0.3cm for 158 patients (81.4%) and were ≥0.5cm in only 12 patients (6.2%). A stapler (57.7%) or hand-sewn closure (42.3%) were used to close the pancreatic remnant. The pancreatic anastomosis techniques used were duct to mucosa pancreaticojejunostomy (PJ)-interrupted suture (47.4%), duct to mucosa PJ-continuous suture (43.3%), duct to mucosa "HO" half-purse binding PJ (5.2%) and invaginating pancreaticogastrostomy (4.1%). Post-surgical incidences of CR-POPF of 45.9%, surgical site infection of 28.9%, postpancreatectomy hemorrhage of 7.7% and delayed gastric emptying of 2.1% were found. Obesity and pancreatic anastomosis technique were independent risk factors of CR-POPF, with a concordance index of 0.675 and an Area Under the Curve of 0.678.

Discussion

This novel nomogram constructed according to obesity and pancreatic anastomosis technique showed moderate predictive performance of CR-POPF after open CP.

Case report: Treatment of intraductal papillary mucinous neoplasms located in middle-segment pancreas with end-to-end anastomosis reconstruction after laparoscopic central pancreatectomy surgery through a pigtail-tube-stent placement of the pancreatic duct

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is one type of pancreatic cystic neoplasm. IPMNs can be classified into three types: main duct-IPMN (MD-IPMN), branch duct-IPMN (BD-IPMN), and mixed type-IPMN (MT-IPMN). It is universally accepted by most surgeons that patients who suffered from MD-IPMN with a high risk of malignant transformation should undergo surgical resection. However, a consensus on the best surgical strategy for MD-IPMN located in the pancreatic neck has still eluded the surgical community worldwide. Recently, one patient suffering from this condition in our Minimally Invasive Pancreas Center underwent a successful surgical procedure. In this case report, we performed a laparoscopic central pancreatectomy for this patient. During this surgical procedure, we used a method of end-to-end anastomosis reconstruction through a pigtail-tube-stent placement of the pancreatic duct. Before the construction of the remnant pancreas, the surgical margins of the frozen section should be negative. After surgery, the outcome of this case was satisfactory. No complications such as postoperative hemorrhage, abdominal infection, pancreatitis, delayed gastric emptying, and clinically relevant postoperative pancreatic fistula occurred, which demonstrated that this surgical strategy could achieve a good clinical therapeutic effect for the pancreatic neck MD-IPMN. The result of postoperative routine pathology confirmed the diagnosis of MD-IPMN. The pathological features also showed that there was a high degree of hyperplasia in the local epithelium, which indicated the necessity of surgical treatment.