Limited conservative pancreatectomy for benign tumours: A new techical approach

Fagniez, Pierre-Louis; Kracht, M; Rotman, N

doi:10.1002/bjs.1800750733

Cited by 57 publications

(43 citation statements)

References 5 publications

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“…The main reservations reported regarding this technique have to do with the increased risk of pancreatic fistulas, the incidence of which, in the literature, ranges from 0% to 54%, with a degree of variability due to the limited sizes of the patient series [2,[23][24][25][26][30][31][32][33][34]. The mean incidence of fistulas, based on an overall evaluation of the data, is, however, only slightly greater than that encountered after pancreatico-duodenectomy.…”

Section: Early and Late Resultsmentioning

confidence: 99%

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Indications and technique of central pancreatectomy—early and late results

Iacono

Bortolasi

Serio

2005

Langenbecks Arch Surg

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Section: Early and Late Resultsmentioning

confidence: 99%

“…and subsequently publicized by Serio and Iacono with many reports in the national and international literature as well as congress communications and videotapes . Also, other authors have reported on their use of this technique [23][24][25][26].…”

Section: Historymentioning

confidence: 99%

Indications and technique of central pancreatectomy—early and late results

Iacono

Bortolasi

Serio

2005

Langenbecks Arch Surg

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“…CP (also known as middle pancreatectomy or median pancreatectomy) was first ascribed to Ehrhardt in 1908 (2,3). Guillemin and Bessot performed the first CP with pancreato-enteric reconstruction in 1957 for chronic pancreatitis, and subsequently Dagradi and Serio described the operation for resection of a benign lesion (insulinoma) in 1982 (1,(4)(5)(6). 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).…”

Section: Introductionmentioning

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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“…For surgeons, this is partly because the surgical treatment of pancreatic diseases has generally been considered to be associated with a high incidence of postoperative complications, and has developed to preserve as much of the pancreatic parenchyma as possible. Limited pancreatic resections, such as medial pancreatectomy [1][2][3], ventral pancreatectomy [4], uncinate process resection [5], superior head resection [6], and inferior head resection [7] have been performed for benign or low-grade malignant neoplasms of the pancreas, such as mucin-producing tumors, and in some cases for pancreatic injury. These procedures allow maximal preservation of normal pancreatic tissue and hence pancreatic endocrine and exocrine functions, and thus result in a better quality of life for patients [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Anterior Inferior Pancreaticoduodenal Artery Running Between the Dorsal and Ventral Pancreas: Morphological and Embryological Viewpoint

Yi²,

Wang³

et al. 2010

Open Anat J

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Abstract:Objective: To elucidate the configurational relationship of the anterior inferior pancreaticoduodenal artery (AIPD) and embryological ventral/dorsal pancreas anlagen.Methods: 64 cadavers were used for morphological observation by gross dissection of the head and uncinate process of the pancreas as well as its vessels. The localization of pancreatic polypeptide-immunoreactive cells was investigated in 22 cadaveric pancreas samples.Results: In 73.4% subjects, the AIPD appeared not on the anterior surface of the anterior inferior portion of the pancreatic head, but was covered by pancreatic parenchyme. The islets of Langerhans were irregular in shape, and abundant pancreatic polypeptide-immunoreactive cells were identified in the pancreatic tissues of the posterior region of the AIPD, while in the anterior region of the AIPD, the islets of Langerhans were rounded, and few or no pancreatic polypeptideimmunoreactive cells were identified. Conclusions:The AIPD may follow the boundary between the dorsal and ventral pancreas, and we can interpret in embryology of the morphological characteristics by which the AIPD is located behind or on the anterior surface of the anterior inferior portion of the pancreatic head.

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Limited conservative pancreatectomy for benign tumours: A new techical approach

Cited by 57 publications

References 5 publications

Indications and technique of central pancreatectomy—early and late results

Indications and technique of central pancreatectomy—early and late results

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

Anterior Inferior Pancreaticoduodenal Artery Running Between the Dorsal and Ventral Pancreas: Morphological and Embryological Viewpoint

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