Central pancreatectomy for benign pancreatic lesions

Brown, Kimberly M.; Shoup, Margo; Abodeely, Adam; Hodul, Pam; Brems, John J.; Aranha, Gerard V.

doi:10.1080/13651820510037611

Cited by 38 publications

(21 citation statements)

References 24 publications

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“…For this anastomosis, different variants have been proposed; however, the implantation of the open end of the pancreas directly into the gastric pouch through a 2-3-cm opening in its posterior surface is the most frequent technique. This technique is the most frequently used by French [18][19][20] and, recently, American authors [21][22][23][24] ; it has a very low rate of pancreatic fistula and the anastomosis can be directly visualized by endoscopy; the disadvantages are mainly related to the alteration of digestive enzymes, particularly lipase, caused by gastric juice, resulting in an impairment in exocrine function. In our opinion, the alteration of exocrine pancreatic function represents a failure of this conservative operation.…”

Section: Reconstructive Stepmentioning

confidence: 99%

“…[2][3][4][9][10][11]14,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Mortality is low and only one case is reported of a severe complication leading to death (Table 1). In this case, the patient underwent reoperation for leakage of the pancreaticojejunostomy; during surgery, a splenoportal confluence thrombosis was also observed.…”

Section: Postoperative Complications and Managementmentioning

confidence: 99%

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The Dagradi-Serio-Iacono Operation Central Pancreatectomy

Iacono

Bortolasi

Facci

et al. 2007

Journal of Gastrointestinal Surgery

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Central pancreatectomy (CP) is a segmental pancreatic resection indicated to remove benign or low-grade malignant tumors of the isthmus and proximal part of the body of the pancreas. The main advantage of this operation compared with major resections is that it permits to spare normal pancreatic parenchyma; moreover, spleen and upper digestive and biliary tracts are saved. The description of the complete operation was reported for the first time by Dagradi and Serio in 1984 and subsequently spread worldwide by Iacono and Serio. In our opinion, it should be called the Dagradi-Serio-Iacono operation, by the names of the surgeons who first performed it (Dagradi and Serio), and by the names of the surgeons responsible for reporting it worldwide with precise indications (Iacono and Serio). Operation requires a midline or a bilateral subcostal incision; the lesser sac is entered through dissection of the transverse colon from the omentum or by transecting the gastrocolic ligament. The pancreatic segment harboring the lesion is then mobilized and its posterior surface carefully dissected from the splenic vein and artery. Subsequently, the pancreatic portion harboring the tumor is isolated at its superior margin from the splenic artery after the pancreas is transacted. The extent of the resection of the central segment is limited on the right by the gastroduodenal artery and on the left by the need to leave at least 5 cm of normal pancreatic remnant. The resected pancreatic specimen is sent to the pathologist for confirmation of diagnosis and to check if the resection margins are adequate. Hemostasis of the two raw surfaces is achieved with interrupted 5 or 4/0 nonabsorbable stitches. When it is not stapled, the Wirsung's duct of the cephalic stump is sutured selectively with a figure-of-eight nonabsorbable stitch. An end-to-end invaginated pancreaticojejunostomy is carried out with a single layer of interrupted stitches. The operation is concluded with the construction of an end-to-side jejuno-jejunostomy about 50 cm distal to the pancreatic anastomosis. Other techniques for reconstruction of the distal stump using jejunum or stomach have been described. One or two soft drains are brought out on the right side. The fluid collected from this drain is checked for amylase level on postoperative days 3, 5, and 7; if the level is low or absent, the drain is removed. Central pancreatectomy is a safe technique for benign or low malignant tumors of the pancreatic neck that allows curing the tumor with evident functional results without increasing the risk for the patient. We can say that CP has a clear role like pancreaticoduodenectomy and distal pancreatectomy and we think that a pancreatic surgeon has to include this procedure in his/her technical skills. In order to obtain excellent results, correct indications and experience in pancreatic surgery are recommended.

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Section: Reconstructive Stepmentioning

confidence: 99%

Section: Postoperative Complications and Managementmentioning

confidence: 99%

The Dagradi-Serio-Iacono Operation Central Pancreatectomy

Iacono

Bortolasi

Facci

et al. 2007

Journal of Gastrointestinal Surgery

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“…Therefore, an increasing number of patients are now undergoing CPs and have been reported. In select higher volume series on open CP, mean morbidity was found to be 50.3% and mortality 0.7% (1,(7)(8)(9)(10)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) ( Table 2). The mean re-operative rate was 3.9%.…”

Section: Outcomes Of Mis Cpmentioning

confidence: 99%

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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“…A presented method (MCCL) of management in patients with pancreatic fistula may be useful for other researchers. Sperti et al [21] 2000 10 1 40 30 0 Balzano et al [6] 2003 46 2 51 39 0 Efron et al [24] 2004 14 1 50 36 0 Roggin et al [23] 2006 10 1 60 30 0 Brown et al [25] 2006 10 1 60 40 0 Christein et al [22] 2006 8 1 63 63 0 Falconi et al [7] 2007 …”

Section: Peer Reviewmentioning

confidence: 99%