Minimally Invasive Surgery for Pseudopapillary Neoplasm of the Pancreas

Abstract

Background: Solid pseudopapillary pancreatic neoplasia is usually a large well-circumscribed pancreatic mass, with cystic and solid areas more frequently found in young women. It is a benign pancreatic neoplasia in most cases, therefore minimally invasive surgery could be an interesting approach. Aim: Evaluate the results of minimally invasive surgery for this neoplasia. Methods: Patients with this tumor who underwent minimally invasive pancreatectomies between 2009 and 2015 in a single institution, were analyzed regarding demographic, clinical-pathological futures, post-operative morbidity and disease-free survival. Results: All were women, and their median age was 39 (18-54) years. Two patients with tumor in the head of the pancreas underwent laparoscopic pancreaticoduodenectomy, and another one underwent laparoscopic enucleation. Two patients with tumor in the neck underwent central pancreatectomy. Distal pancreatectomies were performed in the other five, one with splenic preservation. None required blood transfusion or conversion to open surgery. Two (20%) developed clinical relevant pancreatic fistulas, requiring readmission. Median length of postoperative hospital stay was five days (2-8). All resection margins were negative. Patients were followed for a median of 38 months (14-71), and there was no recurrence. Conclusions: Minimally invasive surgery for solid pseudopapillary pancreatic neoplasia is feasible for tumors in different locations in the pancreas. It was associated with acceptable morbidity and respected the oncologic principles for treatment.

Pancreaticoduodenectomy: Impact of the Technique on Operative Outcomes and Surgical Mortality

“…Comparing the outcomes observed after GPD or PD, there were no significant differences in any of the surgical variables analyzed, with a mean estimated blood loss of 817 ml and a mean surgical time of 304 min; there was also no differences in the early morbidity or mortality between the two surgical modalities; the overall 30-day mortality was 10.3%. In the literature, there is no difference in morbidity or mortality comparing GPD and PD; the reported mortality is the majority of the series is close to the observed in this study 2 , 6 , 18 . Farges et al 5 , evaluating 22,366 individuals who underwent this procedure in a French national database, observed an overall mortality of 8.1%, whereas Swanson et al 21 ,.…”

Pancreatic Cystic Neoplasms: Diagnosis, Management and Indications for Surgical Procedures. Part II

“…However, in the case of minor patients, taking into account the increased survival rate and the consequences of extensive surgery that considerably lower the quality of life, it is advisable to perform a minimum resection with tissue preservation, such as tumour enucleation whenever possible (64,65,66,67).…”

Laparoscopic Distal Pancreatectomy With Spleen Preservation

“…Laparoscopy has now been introduced as a therapeutic option for treating the majority of digestive system diseases and for other surgical areas, including for more complex procedures, such as hepatobiliopancreatic surgery. Laparoscopic pancreatic surgery began with resection of small and benign lesions (enucleation) and progressed to caudal, total, central and duodenal pancreatectomy procedures 3 , 11 , 12 , 19 . Despite all the technical difficulties inherent to pancreatic surgery, laparoscopic distal pancreatectomy has been gradually included in the routine of various services because their results are similar to those from laparotomy, including in cases of malignant disease 8 , 18 .…”