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.     

Central pancreatectomy in benign tumors of the neck of the pancreas

The surgical treatment of benign tumors of the neck of the pancreas usually consists of enucleation or formal pancreatectomy. Central pancreatectomy has been put forward because it has fewer major complications and can preserve endocrine and exocrine function. Between January 1999 and march 2003, three patients with benign tumors of the neck of the pancreas underwent central pancreatectomy. all patients underwent computed tomography scans, intraoperative ultrasound and frozen-section analysis. pathologic examination showed two mucinous cystadenomas and one serous cystadenoma. after a mean follow-up of 34 months, none of the patients has shown major complications or local recurrence, or has developed diabetes. In conclusion, central pancreatectomy is a useful technique for selected benign or low-grade malignant pancreatic tumors of the neck of the pancreas.     

胰腺中段切除术在胰腺颈体部良性肿瘤的应用(附15例报告)

目的 探讨胰腺中段切除术在胰腺颈体部良性肿瘤中的临床实用价值.方法 对2005年11月至2009年6月期间收治的胰腺颈体部良性肿瘤并施行胰腺中段切除术的15例病例进行回顾性分析,男性3例,女性12例,年龄30～55岁,平均45岁.其中因上腹部胀痛不适入院4例,其余11例均为常规体检行腹部彩色超声检查发现.结果 本组患者无围手术期死亡.15例患者均行胰腺中段切除,其中14例行胰头断端闭锁、胰尾空肠吻术(单吻合术),1例行胰腺两断端空肠"Ω"吻合(双吻合术).术后病理检查结果显示,胰腺实性假乳头状瘤1例,无功能性胰岛细胞瘤3例,胰腺囊腺瘤11例.术后发生胰瘘3例,均在3个月内自行愈合.所有患者均获得随访,随访时间2～45个月,15例患者无死亡,无新发糖尿病,无肿瘤再发,无胰腺假性囊肿形成.结论 胰腺中段切除术治疗胰腺颈体部良性肿瘤临床效果确切,对患者内、外分泌功能影响小,胰瘘发生率高于胰头十二指肠切除术,只要通畅引流,多能自行愈合.     

Distal pancreatectomy for resectable adenocarcinoma of the body and tail of the pancreas

The study goal was to analyze outcome after distal pancreatectomy for three subtypes of adenocarcinoma to determine the role of en bloc resection in surgical management. A secondary aim was to identify those clinicopathologic factors correlating with survival in an analysis limited to ductal adenocarcinoma. Medical records of consecutive patients undergoing distal pancreatectomy for adenocarcinoma between 1987 and 2003 were reviewed. A comparative analysis was undertaken of the safety and outcome of patients undergoing standard and en bloc resections. Clinicopathologic factors for patients undergoing distal pancreatectomy for ductal adenocarcinoma were subjected to both univariate and multivariate survival analyses. Ninety-three patients underwent resection for ductal adenocarcinoma (66, 71%), mucinous cystadenocarcinoma (18, 19%), or adenocarcinoma associated with intraductal papillary mucinous neoplasm (IPMN) (9, 10%). En bloc resection was required in 33 (35%) patients. There was no operative mortality. Median survival was 15.5 months, 30.2 months, and 50.7 months for ductal adenocarcinoma, mucinous cystadenocarcinoma, and adenocarcinoma associated with IPMN, respectively. Patients undergoing en bloc resection had a higher overall complication rate, required more transfusions and more intensive care unit admissions, and had a higher rate of positive margins; however, there were no deaths. For ductal adenocarcinoma, tumor size greater than 3.5 cm, age greater than 60 years, and stage were factors that correlated with survival on a univariate analysis. None were significant on multivariate analysis. Four patients with ductal adenocarcinoma were actual 5-year survivors. While en bloc resections are associated with a higher rate of complications, the majority are self-limited and mortality is low. Resection, including adjacent organs, should be performed when appropriate. Long-term survival for patients with cystadenocarcinoma or IPMN-associated adenocarcinoma can be anticipated. While rare, long-term survival for patients with ductal adenocarcinoma after distal pancreatectomy can be achieved. Presented at the Thirty-Eighth Annual Meeting of the Pancreas Club, New Orleans, Louisiana, May 16, 2004.     

Total pancreatectomy for carcinoma of the pancreas

Survival after partial pancreaticoduodenectomy (Whipple procedure) for carcinoma of the pancreas is uniformly poor. In the absence of nodal metastasis this may be due to extension of tumor beyond the line of resection of the pancreas or to a multicentric origin of the tumor. The material reviewed contained an illustration of the latter circumstance and provides a logical reason for recommending total pancreatectomy as the procedure of choice in resectable pancreatic carcinoma.     

Median resection of pancreas

Experience of 16 median resections of pancreas due to serous or mucinous benign cystic tumor (13 patients) or small afunctional neuroendocrine tumor (3 patients) is analyzed. In all the cases the pathologic process was located at the zone of pancreas isthmus. The long-term results were followed-up at 13 patients from 2 to 14 years (mean followed-up - 8 ys). There were no recurrences of tumor. It is concluded that median resection of pancreas is effective and safe surgical operation for the patients with localization of benign tumor at the zone of pancreatic istmus.     

经腹腔镜胰体尾部切除术治疗胰腺良性肿瘤

目的 探讨腹腔镜胰体尾部切除治疗胰腺良性肿瘤的方法 及安全性、可行性.方法 2009年11月到2010年5月,对3例胰腺体尾部占位性病变的病人实施了腹腔镜胰体尾部切除术(1例保留脾脏,2例联合脾脏切除).结果 所有手术均在手辅助腹腔镜下成功完成.手术时间75～185 min,平均120 min;出血量90～210 ml...     

Results of total pancreatectomy for adenocarcinoma of the pancreas

HYPOTHESIS: Total pancreatectomy for infiltrating ductal adenocarcinoma is not superior to pancreaticoduodenectomy or distal pancreatectomy. DESIGN: A retrospective analysis of a prospective database of patients. SETTING: Memorial Sloan-Kettering Cancer Center, New York, NY. PATIENTS: All patients (n = 488) undergoing pancreatic resection. MAIN OUTCOME MEASURES: Duration of operation, estimated blood loss, complications, length of stay, number of positive lymph nodes, presence of a positive margin, and survival times were analyzed. RESULTS: Thirty-five patients were identified who underwent total pancreatectomy, 28 of whom had adenocarcinoma. Median length of stay was 32 days; 19 (54%) developed postoperative complications, of which 63% were infectious. Thirty-day mortality was 3% (1 patient). Median survival was 9.3 months (range, 0.6-172 months). There was no significant difference between patients with and without adenocarcinoma in terms of duration of operation, estimated blood loss, complications, length of stay, or number of readmissions. In patients with adenocarcinoma, margin or nodal status were not significant survival variables. Patients undergoing total pancreatectomy for adenocarcinoma had a significantly worse overall survival than those undergoing total pancreatectomy for other reasons (P<.001), or compared with a contemporaneous cohort with adenocarcinoma undergoing pancreaticoduodenectomy (n = 409) and distal pancreatectomy (n = 51) (7.9 vs 17.2 months; P<.002). CONCLUSIONS: Total pancreatectomy can be performed safely with low mortality; survival is predicted by the underlying pathologic findings: patients undergoing total pancreatectomy for adenocarcinoma have a uniformly poor outcome. Those undergoing total pancreatectomy for benign disease or nonadenocarcinoma variants can have long-term survival. In patients who require total pancreatectomy for ductal adenocarcinoma, the survival is so poor as to bring into question the value of the operation.     

Laparoscopic distal pancreatectomy for inflammatory pseudotumor of the pancreas

An 82-year-old woman presented with abdominal pain, nausea, emesis, and weight loss of ~25 lb over 6 months. A CT scan and MRI of the abdomen revealed a mass in the tail of the pancreas that was suspicious for malignancy. The patient underwent successful laparoscopic distal pancreatectomy and was discharged home on the 4th postoperative day after an uneventful course. Pathology revealed an inflammatory pseudotumor of the pancreas (IPT). Pancreatic IPT is a rare entity, and this case represents the first report of laparoscopic resection of this lesion. The presentation, diagnosis, histologic features, and therapy of IPT of the pancreas are reviewed.     

Middle-preserving pancreatectomy for multicentric body-sparing lesions of the pancreas

Background

The appropriate surgical approach of a pancreatic multifocal disease that skips the body of the gland remains unknown. We sought to analyze a parenchyma-sparing surgical technique consisting of a middle-preserving pancreatectomy (MPP) evaluating feasibility, safety, and oncological and functional outcomes.

Patients and methods

Between 1999 and 2007, 5 patients affected by pancreatic benign or slow malignant multicentric body-sparing disease underwent MPP.

Results

There were 3 men and 2 women with a median age of 35 years (range 28-70 years). The median operative time was 365 minutes (range 330-440 minutes). Postoperative mortality was nil and postoperative morbidity was 1 (20%). At a median follow-up of 20 months (range 14-118 months) all of the patients are alive and disease-free. Overall, 2 patients developed insulin-dependent diabetes mellitus, as well as exocrine insufficiency. One patient developed only exocrine insufficiency.

Conclusions

MPP is a feasible procedure and might reduce the risk of both endocrine and exocrine insufficiency.     

Islet autotransplantation for the prevention of surgical diabetes after extended pancreatectomy for the resection of benign tumors of the pancreas

OBJECTIVE: The objective of this article is to report a single-center experience with islet autotransplantation after extensive pancreatic resection for benign tumors of the pancreas. MATERIALS AND METHODS: Seven patients underwent extensive left pancreatectomy for benign lesions located at the neck of the pancreas. Once an unequivocal diagnosis of a benign nature was ascertained, the rest of the specimen was processed and the unpurified pancreatic digest was infused into the portal vein. The results were compared with those of 8 autotransplantations performed for chronic pancreatitis over the same period. RESULTS: Tumors were 4 cystadenomas, 2 insulinomas and 1 neuroendocrine tumor. Mean islet yields were 275,000 islet equivalents (IEQ) versus 129,000 in chronic pancreatitis (P =.04) or 6700 IEQ/g of tissue versus 1900 (P =.002), resulting in transplantation of 4200 IEQ/kg body weight vs 2150 in chronic pancreatitis (P =.03), respectively at 4-month to 7.5-year follow-up, all patients are alive and 6 of 7 are off insulin. All patients off insulin after at least 1 year currently have a normal IVGTT, with K values ranging between -1.19 and -2.36 (normal < -1.00). All patients, including 1 on insulin, display positive basal and glucagon-stimulated C-peptide levels. CONCLUSIONS: Compared with chronic pancreatitis tissue resected for benign tumors is more likely to achieve good islet yields, and thus insulin independence after autotransplantation. Islet autotransplantation should be considered when extensive pancreatectomy is required for resection of a benign tumor, and only if the benign nature of the lesion is demonstrated unequivocally.     

腹腔镜胰体尾切除治疗神经内分泌肿瘤单中心研究

目的:探讨腹腔镜手术治疗胰体尾部神经内分泌肿瘤的可行性及安全性。方法:回顾分析2015年8月至2019年6月收治的20例胰体尾部神经内分泌肿瘤行腹腔镜胰体尾切除术患者的临床资料,按肿瘤大小匹配(1:2)胰体尾神经内分泌肿瘤行开放胰体尾切除术的患者资料进行对比分析。结果:开放组与腹腔镜组手术时间差异无统计学意义(P0.05),腹腔镜组出血量、术后疼痛评分、术后住院时间、术后首次排气时间、开放饮食时间、下床活动时间及引流管拔除时间优于开放组(P0.05)。开放组与腹腔镜组总体并发症发生率(55%vs. 40%)差异无统计学意义(P0.05)。结论:腹腔镜手术治疗胰体尾神经内分泌肿瘤创伤小、康复快,安全、可行,可使患者获益。     

Laparoscopic distal pancreatectomy for blunt injury to the pancreas

   apd: 14 May 2001     

Cytoreduction results in high perioperative mortality and decreased survival in patients undergoing pancreatectomy for neuroendocrine tumors of the pancreas

We reviewed our experience with pancreatectomy for neuroendocrine tumors (NE) to determine outcomes after R0/R1 or R2 resection and compare them to patients in whom resection was not attempted. Data were reviewed for all patients presenting with NE tumors of the pancreas between 1990 and 2005. Kaplan-Meier survival curves were compared by log-rank analysis. Multivariate analysis was completed using Cox proportional hazards to identify risk factors for poor survival after resection. Of 120 patients, 65 (54%) had functional tumors. Resection was undertaken in 83: distal pancreatectomy in 41, pancreaticoduodenectomy in 27, enucleation in 14, and central pancreatectomy in 1. Survival was significantly longer after resection (91 months versus 24, P<0.001). R0/R1 resection was accomplished in 64 (77%) and resulted in lower perioperative mortality (2% versus 21%, P<0.01) and longer survival (112 months versus 24, P<0.001) compared to R2 resection. Survival after R2 resection was no better than after no resection. Factors predictive of decreased survival were moderate/poor differentiation, R2 resection, and high-risk features. Long-term survival is possible following complete resection for NE tumors of the pancreas. However, cytoreduction resulting in incomplete tumor removal carries significant perioperative mortality without long-term survival benefit and should be discouraged. Presented at the Forty-Seventh Annual Meeting of The Society for Surgery of the Alimentary Tract, Los Angeles, California, May 22, 2006.     

Laparoscopic distal pancreatectomy for lymphoepithelial cyst of the pancreas.

Lymphoepithelial cysts are rare pancreatic lesions. This case report describes the first excision of such a lesion by laparoscopic distal pancreatectomy which is a recognized procedure for treatment of cystic pancreatic neoplasms. Our patient underwent complete excision of the lesion and has enjoyed complete resolution of his symptoms. Laparoscopic distal pancreatectomy may be a suitable choice for first-line therapy for such lesions.