Central pancreatectomy for solid pseudopapillary neoplasm: A pancreatic-preserving procedure

Introduction and importanceSolid pseudopapillary neoplasm (SPN) is a rare pancreatic disorder that usually affects young women with no or nonspecific clinical manifestation. It accounts for approximately 1% of pancreatic neoplasms. The incidence of SPN is increasing, owing to improved imaging techniques and better recognition of this entity. Although most patients with SPNs have a favorable prognosis after radical resection, local recurrence or metastasis still occurs after surgery.Case presentationWe present a 15-year-old female with a small solid pseudopapillary neoplasm in the Pancreas' proximal body. The patient presented with nonspecific symptoms and was diagnosed incidentally.Clinical DiscussionThe patient underwent a central pancreatectomy and was discharged on the fifth postoperative day without complications. Central pancreatectomy may prevent devastating complications of pancreaticoduodenectomy surgery.ConclusionAs SPN is a rare entity of pancreatic tumors, the surgical options for management are still debated. The respect for surgery should account for the tumor site and size. Also, life expectancy and surgical complications for each choice should be considered. In localized disease, segmental resection may prevent devastating complications of radical resection.     

Laparoscopic pancreatectomy: An initial experience

Three cases of laparoscopic pancreatectomy that were successfully performed during the period 1999–2000 are reported. Pancreatectomy is indicated for patients with cystic neoplasm and intrapancreatic pseudocyst causing repeated episodes of pancreatitis. The role of laparoscopy is no longer confined to the areas of diagnosis, staging and palliation. With refinement of the technique and available instruments, laparoscopic pancreatectomy is now not only feasible but might even be a better option in selected cases.     

Central pancreatectomy with pancreaticogastrostomy for benign pancreatic pathology

Benign lesions of the neck and proximal body of the pancreas pose an interesting surgical challenge. If the lesions are not amenable to simple enucleation, surgeons may be faced with the choice of performing a right-sided resection (pancreaticoduodenectomy) or a left-sided resection (distal pancreatectomy) to include the lesion, resulting in resection of a substantial amount of normal pancreatic parenchyma. Central pancreatic resection has been reported with Roux-en-Y pancreaticojejunostomy reconstruction; however, this interrupts small bowel continuity and obligates an additional anastomosis.We have reviewed our experience with central pancreatectomy with pancreaticogastrostomy (PG) for benign central pancreatic pathology. Between January 1999 and December 2002, 14 central pancreatectomies were performed with PG reconstruction. There were 7 women and 7 men with a mean age of 60.9 years. Five resections were performed for islet cell tumors, three were performed for noninvasive intraductal papillary mucinous neoplasms, two were performed for serous cystadenoma, and one each was performed for a simple cyst, pseudocyst, mucinous metaplasia, and focal chronic pancreatitis. Seven out of 14 patients experienced a total of 10 complications. Pancreatic fistulae manifested by drainage of amylase-rich fluid from the operatively placed drains developed in 5 patients (36%). Reoperation or interventional radiologic procedures were not required in any patient with a fistula. Postoperative follow-up demonstrated 13 out of 14 patients to be alive and well without evidence of pancreatic insufficiency. One patient died at home on postoperative day 57 of cardiac pathology. Central pancreatectomy withPGis a safe and effective procedure that allows for preservation of pancreatic endocrine and exocrine function without disruption of enteric continuity. The complication of pancreatic fistula was managed conservatively via maintenance of operatively placed drains. Presented at the Forty-Fourth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Florida, May 18–21, 2003 (poster presentation).     

Central pancreatectomy for pancreatoblastoma in a 16-year-old girl

Long-term functional results after standard pancreatic resections are a major concern, especially in children. An alternative pancreas-sparing procedure (such as central pancreatectomy) should be taken into consideration whenever it is feasible, and a prolonged survival is expected. Pancreatoblastoma is an unusual malignant tumor in childhood. However, in initially resectable tumors, the 15-year survival is more than 80%. Thus, there is a potential role of a conservative pancreatic resection in successful treatment of pancreatoblastoma. The management in a case of a 16-year-old girl with a pancreatoblastoma in the body of pancreas is presented. Complete surgical resection by central pancreatectomy followed by chemotherapy led to a prolonged disease-free survival, with good functional results. Central pancreatectomy could be an alternative surgical technique in some selected cases of pancreatoblastoma, having the lowest incidence of postoperative exocrine and endocrine insufficiency rate and offering the best nutritional status.     

中段胰腺切除治疗胰颈体部肿瘤13例体会

目的总结中段胰腺切除治疗胰颈体部肿瘤的临床经验。方法对胰颈体部良性或低度恶性肿瘤13例患者行中段胰腺切除术治疗。术中游离胰颈体部切除肿瘤,行Roux-en-Y胰肠吻合或胰胃吻合。单吻合法5例,"Ω"形双吻合法6例,胰胃吻合法2例,胰肠吻合均放置肠造口管充分减压引流。结果切除胰腺平均直径4.3 cm,手术时间(237±43)分钟,出血量(287±75)ml。术后胰瘘2例,出血2例。浆液性囊腺瘤2例,黏液性囊腺瘤1例,实性假乳头状瘤3例,导管内乳头状黏液瘤2例,神经内分泌瘤1例,神经鞘瘤1例,功能性胰岛细胞瘤2例,无功能性胰岛细胞瘤1例。均痊愈出院,平均住院时间(18±5)天,随访9个月~3年未见低血糖和肿瘤复发及新发糖尿病。结论个体化中段胰腺切除术适合胰颈体部良性或低度恶性肿瘤治疗,保护了胰腺内外分泌功能,是一种安全、疗效确切的手术方式。     

Central pancreatectomy with pancreaticogastrostomy reconstruction: A brief report and video technique

Low grade tumors located in the neck of the pancreas present a unique surgical challenge. Subtotal pancreatectomy results in significant loss of pancreatic gland and function, while pancreaticoduodenectomy may be too aggressive for these lesions. We present a case of a patient with a well differentiated neuroendocrine tumor in the neck of the pancreas who underwent a central pancreatectomy with pancreaticogastrostomy reconstruction. Patient selection and technical aspects of the procedure are described. The decision to perform a central pancreatectomy should not be made lightly as complications are frequent. Careful patient selection is imperative.     

Case-control comparison of laparoscopic versus open distal pancreatectomy

Laparoscopic distal pancreatectomy is becoming an increasingly used modality in the surgical treatment of pancreatic disease. The assumption is that this will lead to shorter hospitalization and faster recovery. However, actual comparative data between open and laparoscopic distal pancreatectomy is lacking. The purpose of this study is to compare these surgical procedures. All patients who underwent either laparoscopic or open distal pancreatectomy/splenectomy were reviewed. Fifteen patients underwent laparoscopic resection, whereas 41 underwent an open resection. The 15 laparoscopic patients were matched to 15 open patients for age, gender, and pancreatic pathology. Data gathered included length of stay, pancreatic leak, postoperative complications, and return to normal activity. Of the 15 laparoscopic patients, three were converted to open operations. Laparoscopic patients had a median length of stay of 5 days (range, 3–9) compared with 8 days (range, 6–23) for the open patients (P = 0.02). The pancreatic leak rate was 13% in each group. Overall postoperative complication rate was 20% in the laparoscopic group compared with 27% in the open group. Laparoscopic patients reported a return to normal activity in 3 weeks (range, 2–7) compared with 6 weeks (range, 4–10) for open patients (P =0.03). Laparoscopic distal pancreatectomy/splenectomy does lead to shorter hospital stay and faster return to normal activity. Pancreatic leak rate and overall complication rate appear similar. Presented at the 2005 American Hepato-Pancreato-Biliary Association Congress, Hollywood, Florida, April 14–17, 2005 (poster presentation).     

Central pancreatectomy for benign or low-grade malignant pancreatic tumors in the neck and body of the pancreas

BACKGROUNDFor 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.AIMTo 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.METHODSThis 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.RESULTSNo 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).CONCLUSIONCP 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.     

Laparoscopic distal pancreatectomy for traumatic pancreatic transection

Laparoscopic pancreatic surgery has been discussed but remains relatively limited to resection for benign disease. Laparoscopic intervention for pancreatic trauma has been documented briefly, and the authors now report a case of traumatic pancreatic transection managed by laparoscopic distal pancreatectomy.     

Laparoscopic central pancreatectomy

BACKGROUND: The role of mini-invasive surgery in pancreatic surgery is still being debated. Indications and results are still controversial. Only a few centers in the world report on laparoscopic pancreatic resections. With the aim of improving the use of minimally invasive surgery, we have devised a novel laparoscopic procedure for surgical treatment of neuroendocrine tumor of the neck of the pancreas. METHODS: A central laparoscopic pancreatic resection was successfully performed. The pancreatic resection was performed using the harmonic scalpel. The duct was isolated and transected. The proximal duct stump was closed by an endoscopic stitch. The pancreaticojejunostomy was intracorporeally performed using a Roux-en-Y loop. RESULTS: Histologic findings showed a well differentiated neuroendocrine tumor. Operating time was 330 minutes and blood loss 300 mL. The postoperative course was uneventful. CONCLUSIONS: Laparoscopic central pancreatectomy is a feasible and safe procedure. The minimally invasive approach ensures an adequate treatment despite requiring the expertise of highly skilled laparoscopic surgeons.     

中段胰腺切除术与远端胰腺切除术术后并发症及远期生存质量比较的meta分析

目的探讨中段胰腺切除术和远端胰腺切除术术后并发症的差异和远期生存质量的区别。方法计算机检索在2015年12月31日前在Medline、Embase、Web of science、Science direct、Springer link、Cochrane center数据库上公开发表的关于CP和DP手术术式选择的随机对照试验或严格设计的临床对照试验。按纳入排除标准由2位研究者独立进行文献筛选(PRISMA标准)、资料提取和方法学质量评价后,采用Rev Man 5.2软件进行Meta分析。结果共纳入文献10篇,共包含病例数797例,其中行CP例数为355例,行DP例数为442例。Meta分析表明:在术后并发症方面:CP和DP在术后胰瘘[RR=1.46,95%CI(1.07~2.10),P=0.02]、手术时间[WMD 33.40,95%CI(16.36,50.43),P=0.0001];术中失血量[WMD-129.06,95%CI(-233.28,-24.84),P=0.02]和术后总体并发症[RR 1.30,95%CI(1.05,1.62),P=0.02]的差异有统计学意义(P0.05)。而在术后的住院时间、再手术、出血和病死率的差异无统计学意义(P0.05)。远期胰腺内分泌功能障碍[RR=1.46,95%CI(1.07~2.10),P0.05]、胰腺外分泌功能不全[RR=0.61,95%CI(0.44~0.86),P=0.004]的差异有统计学意义。结论中段胰腺切除术由于在术后胰腺内分泌功能障碍和外分泌功能不全低于远端胰腺切除术,值得临床上推广,但需要严格把握手术指征和术后管理,但仍需多中心、大样本、前瞻性RCT研究验证。     

Central pancreatectomy for neoplasm of mid pancreas — a report of four cases

Central pancreatectomy (CP) originally done for pancreatic trauma and focal pancreatitis is recently being performed for benign and low grade malignant neoplasm of mid pancreas. It offers the advantage of conserving pancreatic tissue and preserving gastroduodenal-biliary anatomy, important for maintenance of endocrine and exocrine pancreatic function. We reviewed our database between Jan. 2005 and June 2007. Four patients (2 males and 2 females) in the age range of 12 to 55 years underwent CP for a mass in the mid pancreas. Two were known diabetic. Histology reported solid variant of serous cystadenoma (1), solid pseudopapillary tumor (1), focal pancreatitis (1) and ductal adenocarcinoma (1). Postoperatively one patient had transient pancreatic fistula which was managed conservatively. There was no mortality. On follow-up (7 to 43 months) none of the patients required enzyme supplements and diabetes did not worsen. Patient with ductal adenocarcinoma progressed within 7 months. CP may be a viable option for mid pancreatic lesions of benign or low grade malignant potential.     

2015年美国胃肠病学会《无症状性胰腺囊性肿瘤诊治指南》解读

随着现代医学影像学的不断发展与进步,越来越多的胰腺囊性疾病被检出。相对于胰腺假性囊肿,胰腺囊性肿瘤的诊治尚存较多争议与不足,而循证医学证据的欠缺也导致国际上尚无权威性规范可供遵循。最近,美国胃肠病学会针对无症状性胰腺囊性肿瘤提出了10条共识性专家建议及相应的诊治方案,主张放宽监测及随诊间期、收紧手术指征。     

机器人手术系统行胰腺中段切除的临床应用

目的初步研究利用机器人手术系统行胰腺中段切除术的临床应用价值。方法回顾性分析解放军总医院2015年3月至2016年6月期间行机器人胰腺中段切除术的病人的临床资料。结果共开展8例机器人胰腺中段切除术,均顺利完成,达到R0切除,无中转开腹,其中行胰胃吻合术3例,胰肠吻合术5例。手术平均时长为(283±43)min,术中平均出血量为(94±27)ml。实性假乳头状瘤4例,神经内分泌肿瘤2例,导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)1例,囊腺瘤1例。术后平均住院时间为(9.3±0.7)d,所有病人均康复出院,无病人死亡。结论机器人胰腺中段切除术技术上安全、可行,具有一定的临床应用价值。     

胰腺中段切除术在胰腺疾病中应用(附17例报告)

目的 探讨胰腺中段切除术在治疗胰腺颈体部疾病的可行性及临床应用价值.方法 回顾分析西安交通大学第一附属医院2006年6月～2012年3月17例胰腺颈体部疾病患者实施胰腺中段切除术的临床资料,胰岛细胞瘤4例(2例为无功能性),黏液性囊腺瘤4例,浆液性囊腺瘤3例,实性假乳头状瘤3例,非侵袭性胰管内乳头状粘液癌2例(病理科已核实),外伤胰腺颈体部横断伤1例.结果 17例均行胰腺中段切除,胰体空肠Roux-en-Y吻合14例,胰头、胰体空肠双吻合3例,术后胰瘘5例(29.4％),出血2例(11.8％),经非手术治疗后痊愈.随访时间5个月-2年,1例因腹腔转移多器官衰竭术后5个月死亡;1例术后8个月因心脑血管疾病死亡;其余均存活,且随访期血糖监测正常,无其它并发症.结论 对于胰腺颈体部良性或低度恶性肿瘤,胰腺中段切除术是一种比较理想的手术方式,该术式能最大程度保留胰腺组织,维持胰腺的内、外分泌功能,维持上消化道连续性,可获得满意的治疗效果.