|
1
|
Sun MQ, Kang XM, He XD, Han XL. Laparoscopic spleen-preserving total pancreatectomy for the treatment of low-grade malignant pancreatic tumors: Two case reports and review of literature. World J Clin Cases 2024; 12:3206-3213. [PMID: 38898831 PMCID: PMC11185369 DOI: 10.12998/wjcc.v12.i17.3206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/04/2024] [Accepted: 04/18/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Function-preserving pancreatectomy can improve the long-term quality of life of patients with benign or low-grade malignant tumors, such as intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms. However, there is limited literature on laparoscopic spleen-preserving total pancreatectomy (L-SpTP) due to technical difficulties. CASE SUMMARY Patient 1 was a 51-year-old male diagnosed with IPMN based on preoperative imaging, showing solid nodules in the pancreatic head and diffuse dilation of the main pancreatic duct with atrophy of the distal pancreas. We performed L-SpTP with preservation of the splenic vessels, and the postoperative pathology report revealed IPMN with invasive carcinoma. Patient 2 was a 60-year-old male with multiple cystic lesions in the pancreatic head and body. L-SpTP was performed, and intraoperatively, the splenic vein was injured and required ligation. Postoperative pathology revealed a mucinous cystic tumor of the pancreas with low-grade dysplasia. Both patients were discharged on postoperative day 7, and there were no major complications during the perioperative period. CONCLUSION We believe that L-SpTP is a safe and feasible treatment for low-grade malignant pancreatic tumors, but more case studies are needed to evaluate its safety, efficacy, and long-term outcomes.
Collapse
Affiliation(s)
- Meng-Qing Sun
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiao-Man Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiao-Dong He
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xian-Lin Han
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| |
Collapse
|
|
2
|
Outcomes After Minimally Invasive Versus Open Total Pancreatectomy: A Pan-European Propensity Score Matched Study. Ann Surg 2023; 277:313-320. [PMID: 34261885 DOI: 10.1097/sla.0000000000005075] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess postoperative 90-day outcomes after minimally invasive (laparoscopic/robot-assisted) total pancreatectomy (MITP) in selected patients versus open total pancreatectomy (OTP) among European centers. BACKGROUND Minimally invasive pancreatic surgery is becoming increasingly popular but data on MITP are scarce and multicenter studies comparing outcomes versus OTP are lacking. It therefore remains unclear if MITP is a valid alternative. METHODS Multicenter retrospective propensity-score matched study including consecutive adult patients undergoing MITP or OTP for all indications at 16 European centers in 7 countries (2008-2017). Patients after MITP were matched (1:1, caliper 0.02) to OTP controls. Missing data were imputed. The primary outcome was 90-day major morbidity (Clavien-Dindo ≥3a). Secondary outcomes included 90-day mortality, length of hospital stay, and survival. RESULTS Of 361 patients (99MITP/262 OTP), 70 MITP procedures (50 laparoscopic, 15 robotic, 5 hybrid) could be matched to 70 OTP controls. After matching, MITP was associated with a lower rate of major morbidity (17% MITP vs. 31% OTP, P = 0.022). The 90-day mortality (1.4% MITP vs. 7.1% OTP, P = 0.209) and median hospital stay (17 [IQR 11-24] MITP vs. 12 [10-23] days OTP, P = 0.876) did not differ significantly. Among 81 patients with PDAC, overall survival was 3.7 (IQR 1.7-N/A) versus 0.9 (IQR 0.5-N/ A) years, for MITP versus OTP, which was nonsignificant after stratification by T-stage. CONCLUSION This international propensity score matched study showed that MITP may be a valuable alternative to OTP in selected patients, given the associated lower rate of major morbidity.
Collapse
|
|
3
|
Scholten L, Latenstein AE, Aalfs CM, Bruno MJ, Busch OR, Bonsing BA, Koerkamp BG, Molenaar IQ, Ubbink DT, van Hooft JE, Fockens P, Glas J, DeVries JH, Besselink MG. Prophylactic total pancreatectomy in individuals at high risk of pancreatic ductal adenocarcinoma (PROPAN): systematic review and shared decision-making programme using decision tables. United European Gastroenterol J 2020; 8:865-877. [PMID: 32703081 PMCID: PMC7707864 DOI: 10.1177/2050640620945534] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Individuals with a very high lifetime risk of developing pancreatic ductal adenocarcinoma; for example, hereditary pancreatitis and main-duct or mixed-type intraductal papillary mucinous neoplasm, may wish to discuss prophylactic total pancreatectomy but strategies to do so are lacking. Objective To develop a shared decision-making programme for prophylactic total pancreatectomy using decision tables. Methods Focus group meetings with patients were used to identify relevant questions. Systematic reviews were performed to answer these questions. Results The first tables included hereditary pancreatitis and main-duct or mixed-type intraductal papillary mucinous neoplasm. No studies focused on prophylactic total pancreatectomy in these groups. In 52 studies (3570 patients), major morbidity after total pancreatectomy was 25% and 30-day mortality was 6%. After minimally invasive total pancreatectomy (seven studies, 35 patients) this was, respectively, 13% and 0%. Exocrine insufficiency-related symptoms occurred in 33%. Quality of life after total pancreatectomy was slightly lower compared with the general population. Conclusion The decision tables can be helpful for discussing prophylactic total pancreatectomy with individuals at high risk of pancreatic ductal adenocarcinoma.
Collapse
Affiliation(s)
- Lianne Scholten
- Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Cora M Aalfs
- Department of Clinical Genetics, University of Amsterdam, Amsterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Olivier R Busch
- Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - I Quintus Molenaar
- Department of Surgery, St Antonius Hospital Nieuwegein and University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands
| | - Dirk T Ubbink
- Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, University of Amsterdam, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, University of Amsterdam, The Netherlands
| | - Jolanda Glas
- Dutch Pancreatic Cancer Patient Organisation, 'Living with Hope', Utrecht, The Netherlands
| | - J Hans DeVries
- Department of Internal Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc G Besselink
- Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
|
4
|
Abstract
Laparoscopic total pancreatectomy (LTP) is technical challenging and rarely reported in the literature. Herein, we introduced a safe and feasible approach to perform LTP basing on our own experience.Over the period of July 2015 to August 2018, we performed 13 cases of LTP at our institution. Demographic characteristics, intraoperative and postoperative variables, and follow-up outcomes were prospectively collected. The surgical procedures were also described in this study.Seven male and six female patients were included in this study. The median age of the patients was 51 years (range 29-79 years). The median operative time was 355 minutes (range 300-470 minutes). The median estimated blood loss was 200 mL (range 50-1000 mL). The median postoperative hospital stay was 17 days (range 12-23 days). One patient suffered from bile leakage and another patient suffered from delayed gastric emptying. Both patients cured with conservative therapy.Laparoscopic total pancreatectomy can be safely and feasibly performed in well-selected patients.
Collapse
Affiliation(s)
- Yunqiang Cai
- Department of Pancreatic Surgery, West China Hospital, Sichuan University
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China
| | - Pan Gao
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China
| | - Bing Peng
- Department of Pancreatic Surgery, West China Hospital, Sichuan University
| |
Collapse
|
|
5
|
Yang F, Jin C, Warshaw AL, You L, Mao Y, Fu D. Total pancreatectomy for pancreatic malignancy with preservation of the spleen. J Surg Oncol 2019; 119:784-793. [PMID: 30636049 DOI: 10.1002/jso.25377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 12/30/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Total pancreatectomy may be necessary to achieve margin-negative resection for pancreatic cancer. However, despite the desirability of saving the spleen, the feasibility, safety, and oncological outcomes of spleen-preserving total pancreatectomy have not been studied in patients with malignancy involving the pancreatic neck or proximal body. The aim of this study was to report the efficacy of spleen-preserving total pancreatectomy using the Warshaw technique for patients with pancreatic malignancies. METHODS A retrospective analysis of patients who underwent total pancreatectomy for malignant pancreatic diseases between December 2006 and January 2018 focused on comparing the clinical outcomes between conventional operations with splenectomy and spleen-preserving total pancreatectomy using the Warshaw technique. RESULTS Thirty-eight patients among a total of 59 total pancreatectomies had the spleen preservation by the Warshaw operation. In this series, the pancreatic ductal adenocarcinomas resected with the Warshaw technique were of smaller tumor size but had greater rates of vascular invasion, resulting in the more frequent vascular resection. No patients had splenic complications requiring splenectomy, but two patients intended to have the Warshaw operation were converted to splenectomy because of splenic malperfusion. Asymptomatic perigastric varices were noted in 4 patients. Postoperative morbidity and mortality were comparable between the Warshaw and conventional operation groups. Recurrence-free and overall survival was similar in both groups. CONCLUSION In patients with pancreatic malignancy, total pancreatectomy with preservation of the spleen using the Warshaw technique achieves outcomes comparable with conventional total pancreatectomy with splenectomy in selected patients.
Collapse
Affiliation(s)
- Feng Yang
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Chen Jin
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Andrew L Warshaw
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Li You
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Yishen Mao
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - Deliang Fu
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital affiliated to Fudan University, Shanghai, China
| |
Collapse
|
|
6
|
de Mesquita Neto JWB, Macedo FI, Liu Y, Yiengpruksawan A. Fully robotic total pancreatectomy: technical aspects and outcomes. J Robot Surg 2018; 13:77-82. [PMID: 29713931 DOI: 10.1007/s11701-018-0818-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Abstract
Robotic total pancreatectomy (RTP) is a novel surgical approach currently performed by a select group of skilled surgeons. As robotic approaches to pancreatic surgery increase worldwide, rates of RTP are expected to increase. However, the standard technique is still evolving and several technical problems still require evaluation. Here, we describe our approach in a stepwise fashion and discuss solutions to overcome technical difficulties.
Collapse
Affiliation(s)
| | - Francisco Igor Macedo
- Division of Surgical Oncology, Jackson Memorial Hospital and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Detroit, MI, USA
| | - Yang Liu
- Department of Surgery, University Health Center, Wayne State University School of Medicine, 6C, 4201 St. Antoine, Detroit, MI, 48201, USA
| | | |
Collapse
|
|
7
|
Choi YJ, Lee JH, Lee CR, Han WK, Kang CM, Lee WJ. Laparoscopic total pancreatectomy for multiple metastasis of renal cell carcinoma of the pancreas: a case report and literature review. Ann Hepatobiliary Pancreat Surg 2017; 21:96-100. [PMID: 28567455 PMCID: PMC5449372 DOI: 10.14701/ahbps.2017.21.2.96] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 01/19/2017] [Accepted: 01/21/2017] [Indexed: 11/17/2022] Open
Abstract
Advances in surgical techniques and laparoscopic instruments have resulted in the development of laparoscopic pancreatic surgery. Total pancreaticoduodenectomy is performed for treating benign and borderline pancreatic disease involving the whole pancreas. Here, we report a case of metastatic renal cell carcinoma in the pancreas, treated by laparoscopic pylorus-preserving total pancreaticoduodenectomy. A 59-year-old woman was diagnosed with metastatic renal cell carcinoma. Multiple metastatic lesions were found on routine follow-up. She had a history of radical video-assisted right-nephrectomy for renal cell carcinoma (conventional type, pT1) in November 2003, without any recurrence. However, in 2014, a routine health checkup revealed multiple enhancing lesions throughout the pancreas. Positron emission tomography showed a suspicious 4-cm lesion in her left thyroid. Laparoscopic pylorus-preserving total pancreaticoduodenectomy with splenectomy was performed, along with simultaneous left total thyroidectomy with central compartment node dissection for metastatic renal cell carcinomas. The total operation time was 441 min, with an estimated blood loss of 150 ml; no transfusion was administered. Her hospital stay was 12 days. The histopath report confirmed metastatic renal cell carcinoma in the pancreas and left thyroid. Based on literature reviews, we further tried to estimate the oncologic outcome of total pancreatectomy in multiple pancreatic metastasis of renal cell carcinoma. Laparoscopic pylorus-preserving total pancreaticoduodenectomy is feasible and safe, even in cases of metastatic renal cell carcinoma.
Collapse
Affiliation(s)
| | - Jin Ho Lee
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Cho Rok Lee
- Yonsei University College of Medicine, Seoul, Korea
- Division of Thyroid and Endocrine Surgery, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Woong Kyu Han
- Yonsei University College of Medicine, Seoul, Korea
- Department of Urology, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Chang Moo Kang
- Yonsei University College of Medicine, Seoul, Korea
- Division of Hepatobiliary and Pancreatic Surgery, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
- Department of Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Woo Jung Lee
- Yonsei University College of Medicine, Seoul, Korea
- Division of Hepatobiliary and Pancreatic Surgery, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
- Department of Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| |
Collapse
|
|
8
|
Abstract
RATIONALE Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. PATIENTS AND METHODS Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien-Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. DIAGNOSIS AND OUTCOMES The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450-540 minutes), the mean estimated blood loss was 266 mL (range 100-400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8-24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. LESSONS Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy.
Collapse
|
|
9
|
Abstract
An elective total pancreatectomy (TP) was first performed by Eugene Rockey of Portland, Oregon, in 1942. In the 1960s and 1970s, TP was the routine resection for pancreatic cancer in many centers because of fear of a leaking pancreatojejunostomy and multicentricity of the disease but the result used to be dreadful (in today's perspective). However, more recently, postoperative mortality and morbidity after pancreatic resections have improved due to better anastomotic technique and pre-, peri- and postoperative care. Today, TP - despite being a more extensive operation - can be offered with about the same operation risk as that of a Whipple procedure. Also, major improvements in the control of diabetes have been seen and there is actually an ongoing discussion on the actual severity of the diabetic state after TP. Also, the development of modern pancreatic enzyme preparations with sufficient control of endocrine and exocrine pancreatic insufficiency provides options for overcoming the postoperative problems following TP. Due to the improved results, there are today different - and more specific - indications than before for TP: malignant tumors growing from the pancreatic head into the left pancreas, pancreatic head cancer where it is not possible to secure a tumor-free resection margin with extended resection or with dubious changes in the pancreatic main duct at frozen section, recurrent malignancy in the pancreatic remnant, at cancer surgery with resection of the celiac trunk, rescue pancreatectomy after a leaking pancreatojejunostomy with sepsis or bleeding after a Whipple-type first resection, multifocal intraductal papillary mucinous neoplasm with potentially malignant foci present in all parts of the gland, multiple metastases of renal cell carcinoma and melanoma without any residual tumor outside the pancreatic gland (possibly also other specified but uncommon metastatic tumors with a potential for cure by pancreatectomy), multifocal neuroendocrine tumors including multiple endocrine neoplasia and hereditary pancreatic cancer with a high grade of cancer penetration risk for the bearers.
Collapse
Affiliation(s)
- Åke Andrén-Sandberg
- Department of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | | |
Collapse
|
|
10
|
Schlöricke E, Hoffmann M, Kujath P, Shetty GM, Scheer F, Liedke MO, Zimmermann M. Laparoscopic Pylorus- and Spleen-Preserving Duodenopancreatectomy for a Multifocal Neuroendocrine Tumor. VISZERALMEDIZIN 2015; 31:364-9. [PMID: 26989393 PMCID: PMC4789911 DOI: 10.1159/000439335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background In contrast to laparoscopic left pancreatic resection, laparoscopic total duodenopancreatectomy is a procedure that has not been standardized until now. It is not only the complexity that limits such a procedure but also its rare indication. The following article demonstrates the technical aspects of laparoscopic pylorus- and spleen-preserving duodenopancreatectomy. Case Report The indication for intervention in the underlying case was a patient diagnosed with a multiple endocrine neoplasia (MEN) I syndrome and a multifocal neuroendocrine tumor (NET) infiltrating the duodenum and the pancreas. The patient was post median laparotomy which was necessary after jejunal perforation due to a peptic ulcer. The resection was carried out entirely laparoscopically, and the reconstruction, which included a biliodigestive anastomosis and a gastroenterostomy, was carried out by means of a median upper abdomen laparotomy of 7 cm in length through which the resected specimen was also removed. The total operative time was 391 min. The blood loss accounted for 250 ml. The postoperative course was uneventful, and the patient was discharged on the eighth postoperative day. Conclusion Laparoscopic pancreatectomy is a treatment option in carefully selected indications. The complexity of the operation demands a high level of expertise in the surgical team.
Collapse
Affiliation(s)
- Erik Schlöricke
- Visceral, Thoracic and Vascular Surgery, West Coast Hospital Heide, Heide, Germany
| | - Martin Hoffmann
- Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Peter Kujath
- Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ganesh M Shetty
- Institute of Diagnostic and Interventional Radiology, West Coast Hospital Heide, Heide, Germany
| | - Fabian Scheer
- Institute of Diagnostic and Interventional Radiology, West Coast Hospital Heide, Heide, Germany
| | - Marc O Liedke
- Visceral, Thoracic and Vascular Surgery, West Coast Hospital Heide, Heide, Germany
| | - Markus Zimmermann
- Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| |
Collapse
|
|
11
|
Retrospective analysis of short term outcomes after spleen-preserving distal pancreatectomy for sodid pseudopapillary tumours. Int J Surg 2015; 21 Suppl 1:S26-9. [PMID: 26118599 DOI: 10.1016/j.ijsu.2015.06.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/19/2015] [Accepted: 04/10/2015] [Indexed: 02/07/2023]
Abstract
Solid pseudopapillary pancreatic tumour (SPN) is a rare pancreatic tumour representing 0.1%-3% of all exocrine pancreatic tumours. Most SPN show benign and low-grade malignant behaviour; malignant degeneration is observed in 10-15% of the patients. More than 40% of SPN involve the tail of the pancreas leading to a minimal invasive distal pancreatectomy approach. In this report we present the case of a young 22 Caucasian woman suffering from SPN who successfully underwent laparoscopic spleen-preserving distal pancreatectomy. Postoperative course was uneventful. A CT scan control at six months was negative for recurrences. We have also made an analysis of all the laparoscopic treatment of SPN reported in English literature.
Collapse
|
|
12
|
Dallemagne B, de Oliveira ATT, Lacerda CF, D'Agostino J, Mercoli H, Marescaux J. Full laparoscopic total pancreatectomy with and without spleen and pylorus preservation: a feasibility report. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 20:647-653. [PMID: 23430055 DOI: 10.1007/s00534-013-0593-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE Laparoscopic pancreatic surgery is gaining acceptance and clear advantages have been demonstrated in distal resection. Total pancreaticoduodenectomy (TPD) combines the operative steps of distal pancreatectomy and pancreaticoduodenectomy, but facilitates reconstruction and lowers the risk of common complications by avoiding the need for a pancreatic anastomosis. The aim of this report is to analyse the feasibility of laparoscopic total pancreaticoduodenectomy, with and without spleen and pylorus preservation. METHODS Two patients underwent laparoscopic TPD for pancreatic intraductal mucinous neoplasm and endocrine tumors. Total splenopancreaticoduodenectomy (TSP) and pylorus- and spleen-preserving total pancreaticoduodenectomy (PSPTP) were performed. RESULTS The two procedures were successfully completed laparoscopically. PSPTP was more time-consuming (420 vs. 360 min) and had an increased risk of hemorrhage (600 vs. 200 ml) compared with TSP. After both procedures, the postoperative outcome was uneventful and the postoperative length of hospital stay was 8 days. CONCLUSIONS This report confirms the feasibility of full laparoscopic TPD, and presents the first full laparoscopic pylorus- and spleen-preservation technique with conservation of the splenic vessels, without robotic assistance. No conclusions can be drawn from this report, but it shows that the laparoscopic approach provides visual magnification, improved exposure, and delicate manipulation of tissues, which may reproduce the clear advantages of laparoscopic distal pancreatectomy.
Collapse
Affiliation(s)
- Bernard Dallemagne
- Department of Digestive and Endocrine Surgery, Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), University Hospital of Strasbourg, IRCAD, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France.
| | | | | | | | | | | |
Collapse
|
|
13
|
Dokmak S, Aussilhou B, Sauvanet A, Ruszniewski P, Levy P, Belghiti J. Hand-assisted laparoscopic total pancreatectomy: a report of two cases. J Laparoendosc Adv Surg Tech A 2013; 23:539-44. [PMID: 23551033 DOI: 10.1089/lap.2012.0459] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Because of improvement in surgical technique and endocrine and exocrine insufficiency management, total pancreatectomy is being frequently performed, especially for benign or low-potential malignant diseases. The laparoscopic approach is rarely performed. SUBJECTS AND METHODS Our aim is to report two cases operated by the assisted laparoscopic approach and to describe a standardized surgical technique. RESULTS Two patients underwent laparoscopic total pancreatectomy with assisted minilaparotomy or the hand-assisted technique for degenerated intraductal papillary mucinous neoplasms (IPMNs) and neuroendocrine tumors with operative times of 270 and 360 minutes, estimated blood loss of 200 and 300 mL, and a hospital stay of 12 and 18 days, respectively. One patient was re-operated on postoperative Day 10 for bleeding from the hepaticojejunostomy probably related to an inadequate dose of antiproton inhibitors, necessitating refection of the anastomosis with an uneventful course. Pathological examination revealed degenerated IPMNs (T3N1R0) and well-differentiated neuroendocrine tumors (T2NOR0) with complete resection. After 6-10 months of follow-up, the diabetes is well controlled with insignificant episodes of hypoglycemia in 1 patient without any evidence of tumor relapse. CONCLUSIONS In selected patients laparoscopic total pancreatectomy appears safe and had many advantages over the open and other laparoscopic pancreatic resection approaches, including first laparoscopic abdominal exploration and no pancreatic anastomosis. Oncological rules can be respected, but further larger studies are needed before drawing conclusions.
Collapse
Affiliation(s)
- Safi Dokmak
- Department of Hepatobiliary and Pancreatic Surgery, Beaujon Hospital, Clichy, France.
| | | | | | | | | | | |
Collapse
|
|
14
|
The minimally invasive approach to surgical management of pancreatic diseases. Gastroenterol Clin North Am 2012; 41:77-101. [PMID: 22341251 DOI: 10.1016/j.gtc.2011.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Laparoscopic pancreas surgery has undergone rapid development over the past decade. Although acceptability among traditional surgeons has been low, emerging specialty centers are reporting excellent outcomes for advanced and complex operations, such as pancreaticoduodenectomy. A note of caution is necessary: These outstanding results are from skilled surgeons, many of whom are pioneers in the field, who have overcome the learning curve over many years of innovation. As the procedures gain wider practice, outcomes need to be carefully watched because many of these procedures are extremely demanding technically. Although many have suggested that controlled, randomized studies comparing laparoscopic pancreatic resections with open resections are necessary to establish the efficacy of laparoscopic procedure, the cumulative data on the safety and efficacy of the laparoscopic procedure argues against such an approach. The logistic difficulties of conducting such studies will be considerable given patient preferences, the need for multicenter studies, and the rapid adoption of the laparoscopic procedure among experienced pancreatic surgeons. A more reasonable approach to truly evaluate the safety of these procedures is the establishment of a national registry that can measure progress of the field and record outcomes in the wider, nonspecialty community. Hepatobiliary training programs should also establish a minimal standard of training for many of the advanced procedures, such as the pancreaticoduodenectomy, so that the benefit of laparoscopic surgery can be made available outside of just a few specialty centers.
Collapse
|