Central pancreatectomy for pancreatoblastoma in a 16-year-old girl

Dumitraşcu, Traian; Stanciulea, Oana; Herlea, Vlad; Tomulescu, Victor; Ionescu, M

doi:10.1016/j.jpedsurg.2011.04.010

Cited by 10 publications

(5 citation statements)

References 14 publications

(18 reference statements)

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“…Selected cases of malignancies, such as metastases of other neoplasms or pancreatoblastoma, can also be managed safely with a conservative resection [11,14,25,28].…”

Section: Discussionmentioning

confidence: 99%

Central Pancreatectomy versus Spleen-Preserving Distal Pancreatectomy: A Comparative Analysis of Early and Late Postoperative Outcomes

et al. 2012

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Background/Aim: The aim of the present study is to compare the postoperative and long-term outcomes of central pancreatectomy (CP) and spleen-preserving distal pancreatectomy (SPDP). Methods: Clinical, pathological and long-term data were compared between 22 patients who underwent CP and 25 patients who underwent SPDP (2002–2012). Results: The median length of resected pancreas was 8.5 cm in the SPDP group and 5 cm in the CP group (p < 0.001). The median estimated blood loss was significantly lower in the CP group (p = 0.019). Morbidity was 50% for CPs and 40% for SPDPs (p = 0.564). The rate of pancreatic fistulae was 36% for CPs and 40% for SPDPs (p = 0.530). The rate of new-onset diabetes was nil in the successful CP group and 16% in the SPDP group (p = 0.111). Conclusion: Morbidity and pancreatic fistula rates are not higher after CP when compared to SPDP. The loss of normal pancreatic tissue is significantly lower for CP, and thus there is potentially better preservation of the pancreatic endocrine functions. CP should be considered only in selected cases when preservation of the pancreas is of utmost importance, especially for lesions situated at the level of the pancreatic neck.

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“…Selected cases of malignancies, such as metastases of other neoplasms or pancreatoblastoma, can also be managed safely with a conservative resection [11,14,25,28].…”

Section: Discussionmentioning

confidence: 99%

Central Pancreatectomy versus Spleen-Preserving Distal Pancreatectomy: A Comparative Analysis of Early and Late Postoperative Outcomes

et al. 2012

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“…Our technique for CP was previously described elsewhere [ 36 , 37 ]. Patients with a distal pancreatic stump anastomosis with the stomach were excluded.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of Duct-to-Mucosa vs. Invagination Pancreatojejunostomy: Toward a Personalized Approach for Distal Pancreatic Stump Anastomosis in Central Pancreatectomy?

Dumitraşcu

Popescu

2023

JPM

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(1) Background: The jejunum is primarily used for distal pancreatic stump anastomoses after central pancreatectomy (CP). The study aimed to compare duct-to-mucosa (WJ) and distal pancreatic invagination into jejunum anastomoses (PJ) after CP. (2) Methods: All patients with CP and jejunal anastomoses (between 1 January 2002 and 31 December 2022) were retrospectively assessed and compared. (3) Results: 29 CP were analyzed: WJ—12 patients (41.4%) and PJ—17 patients (58.6%). The operative time was significantly higher in the WJ vs. PJ group of patients (195 min vs. 140 min, p = 0.012). Statistically higher rates of patients within the high-risk fistula group were observed in the PJ vs. WJ group (52.9% vs. 0%, p = 0.003). However, no differences were observed between the groups regarding the overall, severe, and specific postpancreatectomy morbidity rates (p values ≥ 0.170). (4) Conclusions: The WJ and PJ anastomoses after CP were comparable in terms of morbidity rates. However, a PJ anastomosis appeared to fit better for patients with high-risk fistula scores. Thus, a personalized, patient-adapted technique for the distal pancreatic stump anastomosis with the jejunum after CP should be considered. At the same time, future research should explore gastric anastomoses’ emerging role.

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“…(1,49) For several special malignancies such as isolated pancreatic metastases of other neoplasia and pancreatoblastoma, a CP was demonstrated to be safe and effective, in selected patients ( figure 1, e). (54,55,57,58) Most of the patients reported in the literature, resected for pancreatic metastases of other neoplasia, underwent standard pancreatic resections (59,60); however, the routine loco-regional lymph nodes dissection was not demonstrated to be of any value. (60) A standard pancreatic resection is recommended for this pathology in several centers (61), but other studies have shown the oncological safety of a parenchyma-sparing resection, when negative resection margins can be obtained.…”

Section: Indications and Contraindications For A Central Pancreatectomentioning

confidence: 99%

Central pancreatectomy revisited

Dumitraşcu¹,

Popescu²

2015

JTMR

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Central pancreatectomy (CP) is a parenchyma-sparing alternative resection to distal pancreatectomy, for benign and low malignant potential tumors located on the pancreatic isthmus and/ or body. Pancreatic metastases of other neoplasia might also benefit after a CP, in selected patients. Dagradi and Serio described the modern technique of CP, while Iacono introduced it in current clinical practice. An open CP represents the standard, but there is an emerging role for the minimally-invasive approach, which might become a standard for CP in experienced centers, particularly for the robotic approach. The rationale of a CP was to preserve the postoperative pancreatic functions because it implies the loss of a minimal amount of normal pancreatic tissue. However, the real clinical benefit of a CP is still controversial. High overall morbidity and pancreatic fistula rates were reported after a CP. However, most of the complications after a CP have been conservatively managed, with almost zero mortality. A CP has a minimal impact on the postoperative pancreatic functions; the diabetes mellitus rate after a CP is significantly lower, compared with the distal pancreatectomies. A proper selection of candidates for a CP is recommended. Thus, tumors located on the pancreatic isthmus are more likely to benefit after a CP, because the alternative surgical technique in these patients is an extended left pancreatectomy, a procedure with increased risk of postoperative pancreatic insufficiencies. Individual patient-related factors should be taken into consideration in the selection of the patients. Thus, a CP should be used in young patients, non-obese and without diabetes mellitus, with a good biological status, which might be able to overcome the potential postoperative complications. A CP can be safely incorporated into an experienced pancreatic surgeon armamentarium, albeit it represents an uncommon pancreatic resection. Abbreviations: Central pancreatectomy (CP); Physiologic and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM).

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Central pancreatectomy for pancreatoblastoma in a 16-year-old girl

Cited by 10 publications

References 14 publications

Central Pancreatectomy versus Spleen-Preserving Distal Pancreatectomy: A Comparative Analysis of Early and Late Postoperative Outcomes

Central Pancreatectomy versus Spleen-Preserving Distal Pancreatectomy: A Comparative Analysis of Early and Late Postoperative Outcomes

Outcomes of Duct-to-Mucosa vs. Invagination Pancreatojejunostomy: Toward a Personalized Approach for Distal Pancreatic Stump Anastomosis in Central Pancreatectomy?

Central pancreatectomy revisited

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