Better preservation of endocrine function after central versus distal pancreatectomy for mid-gland lesions

DiNorcia, Joseph; Ahmed, Leaque; Lee, Minna K.; Reavey, Patrick L.; Yakaitis, Elizabeth A.; Lee, James A.; Schrope, Beth; Chabot, John A.; Allendorf, John D.

doi:10.1016/j.surg.2010.09.003

Cited by 100 publications

(120 citation statements)

References 20 publications

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“…Thus, the reported incidence of postpancreatectomy diabetes varies widely in the literature; for example, reported rates of diabetes after Whipple procedures range from 0% to 50%, [1][2][3][4] and after distal pancreatectomy range from 5% to 42%. [4][5][6] We performed the first population-based study of the incidence and natural history of postpancreatectomy endocrine and exocrine insufficiency in a large database with long follow-up and a precise and uniform definition of disease, and stratified postpancreatectomy insufficiency risk by patient, disease, and resection characteristics.…”

Section: Introductionmentioning

confidence: 99%

Population-Level Incidence and Predictors of Surgically Induced Diabetes and Exocrine Insufficiency after Partial Pancreatic Resection

Elliott

Epelboym

Winner

et al. 2017

TPJ

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Context: Endocrine and exocrine insufficiency after partial pancreatectomy affect quality of life, cardiovascular health, and nutritional status. However, their incidence and predictors are unknown.Objective: To identify the incidence and predictors of newonset diabetes and exocrine insufficiency after partial pancreatectomy.Design: We retrospectively reviewed 1165 cases of partial pancreatectomy, performed from 1998 to 2010, from a large population-based database. Main Outcome Measures: Incidence of new onset diabetes and exocrine insufficiencyResults: Of 1165 patients undergoing partial pancreatectomy, 41.8% had preexisting diabetes. In the remaining 678 patients, at a median 3.6 months, diabetes developed in 274 (40.4%) and pancreatic insufficiency developed in 235 (34.7%) patients. Independent predictors of new-onset diabetes were higher Charlson Comorbidity Index (CCI; hazard ratio [HR] = 1.62 for CCI of 1, p = 0.02; HR = 1.95 for CCI ≥ 2, p < 0.01) and pancreatitis (HR = 1.51, p = 0.03). There was no difference in diabetes after Whipple procedure vs distal pancreatic resections, or malignant vs benign pathologic findings. Independent predictors of exocrine insufficiency were female sex (HR = 1.32, p = 0.002) and higher CCI (HR = 1.85 for CCI of 1, p < 0.01; HR = 2.05 for CCI ≥ 2, p < 0.01). Distal resection and Asian race predicted decreased exocrine insufficiency (HR = 0.35, p < 0.01; HR = 0.54, p < 0.01, respectively). Conclusion:In a large population-based database, the rates of postpancreatectomy endocrine and exocrine insufficiency were 40% and 35%, respectively. These data are critical for informing patients' and physicians' expectations.

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Section: Introductionmentioning

confidence: 99%

Population-Level Incidence and Predictors of Surgically Induced Diabetes and Exocrine Insufficiency after Partial Pancreatic Resection

Elliott

Epelboym

Winner

et al. 2017

TPJ

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“…The incidence rate of new-onset diabetes ranges from 9% to 19.2% after distal pancreatectomy [10,11]. It was reported that the incidence rate of new-onset diabetes/impaired glucose tolerance was 0% after central pancreatectomy versus 16% after spleen-preserving distal pancreatectomy [12], while another study found rates of 14% after central pancreatectomy and 46% after distal pancreatectomy [13]. However, none of these studies evaluated changes in the condition of patients over time after surgery based on variables such as body weight or serum albumin.…”

Section: Conflict Of Interestmentioning

confidence: 99%

The Evaluation of the Early and Late Postoperative Pancreatic Function and Nutritional Status: Central Pancreatectomy Versus Distal Pancreatectomy

Izumo¹

2017

Int J Surg Res Pract

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“…Therefore, CP may be an appropriate alternative for a subset of patients possessing low-grade malignant tumors or benign lesions restricted to the central pancreas (19). The most common indications for CP include neuroendocrine tumors followed by cysts that display indeterminate characteristics such as branch-ducttype IPMNs, and solid pseudopapillary neoplasms (Table 1) (1,7,8,19). Contraindications to this procedure include PDAC, main-duct-type IPMN, neoplastic involvement of adjacent organs, and large lesions where it is impossible to preserve the left pancreatic stump (2).…”

Section: Indications For Cpmentioning

confidence: 99%

“…Extended PD or near-total DP are performed for pancreatic ductal adenocarcinoma (PDAC) or main-duct-type intraductal papillary mucinous neoplasm (IPMN) with potential invasive component, in order to achieve adequate resection of the tumor and also the surrounding lymph nodes, which is not always achievable with CP (7,8). However, for low-grade malignant tumors or benign lesions, use of PD or DP would consequently remove much of the normal pancreatic parenchyma which is likely of no therapeutic benefit (Figure 1).…”

Section: Indications For Cpmentioning

confidence: 99%

“…The primary aim of performing a CP is the preservation of both endocrine and exocrine function of the pancreas while still maintaining oncologic efficacy (7). Specifically, for centrally located low-grade lesions, a DP or PD obligates a substantial volume of the pancreas removed, placing patients at higher risk of post-operative diabetes and exocrine dysfunction (7)(8)(9). In comparison to DP, CP also allows for preservation of spleen (7).…”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive central pancreatectomy and pancreatogastrostomy: current surgical technique and outcomes

2016

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Recent improvements in imaging techniques and more frequent use of cross-sectional imaging have led to an increase in the identification of benign and low-grade lesions of the pancreas. Patients with resectable cancers are commonly treated by either a Whipple procedure or distal pancreatectomy (DP) based on the location of the tumor. Central pancreatectomy (CP) is a less commonly performed operation that has recently been utilized for resection of these now more frequently diagnosed low-grade and benign lesions located in the mid pancreas. Lesions that may have a relatively more indolent nature include branchtype intraductal papillary mucinous neoplasm (IPMNs), mucinous cystic neoplasms, neuroendocrine tumors, and solid pseudopapillary tumors. The goal of a CP is complete extirpation of the lesion, while preserving pancreatic parenchyma to reduce the risks of developing diabetes and exocrine insufficiency (EI). Although open CP has been shown to be safe and efficacious, the outcomes of a minimally invasive approach are still relatively underreported and therefore unknown. In this paper, we describe our surgical approach to performing a CP with an accompanying video demonstration of the key portions of the operation. multiple anastomoses required for restoring continuity of the hepatic duct, pancreatic duct and intestinal tract (1,10). The concerns surrounding CP include high incidence of post-operative pancreatic fistula (POPF) and potentially inadequate oncologic resection in cases of malignancy (9). However, studies have shown that although the rates of POPF after CP are relatively high (20-50%), oftentimes these patients possess soft glands and small ducts, which are both well-established risk factors for POPF (9). Also, in most cases the POPF is clinically insignificant [International Study Group on Pancreatic Fistula (ISGPF) grade A] (9). Therefore, CP is a reasonable approach for centrally located, benign or low-grade pancreatic lesions that allows preservation of pancreas parenchyma and adjacent organs.With increasing utilization of laparoscopic and robotic pancreatectomy, patients can now undergo either an open or minimally invasive surgery (MIS) procedure. Laparoscopic and robotic PD has gained interest due to comparable morbidity, mortality and oncologic outcomes versus open PD when performed in select patients (11-15). For DP, MIS approach has now become the standard of care due to its favorable outcomes in comparison to open DP (11,16). In a recent meta-analysis comparing 1,814 patients undergoing open versus laparoscopic DP, the laparoscopic approach resulted in less blood loss, shorter hospital length of stay (LOS), fewer surgical site infections and lower morbidity (17). Similarly, a MIS approach for CP has become increasingly common with the goal of decreasing the impact of morbidity related to the decreased size of incisions, shorter hospital stays, and shorter time until return to work. While both laparoscopic and robotic CP are being performed, laparoscopy may be somewhat limited giv...

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Better preservation of endocrine function after central versus distal pancreatectomy for mid-gland lesions

Cited by 100 publications

References 20 publications

Population-Level Incidence and Predictors of Surgically Induced Diabetes and Exocrine Insufficiency after Partial Pancreatic Resection

Population-Level Incidence and Predictors of Surgically Induced Diabetes and Exocrine Insufficiency after Partial Pancreatic Resection

The Evaluation of the Early and Late Postoperative Pancreatic Function and Nutritional Status: Central Pancreatectomy Versus Distal Pancreatectomy

Minimally invasive central pancreatectomy and pancreatogastrostomy: current surgical technique and outcomes

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