Long-Term Oncologic Outcome following Duodenum-Preserving Pancreatic Head Resection for Benign Tumors, Cystic Neoplasms, and Neuroendocrine Tumors: Systematic Review and Meta-analysis

Beger, Hans G.; Mayer, Benjamin; Poch, Bertram

doi:10.1245/s10434-024-15222-y

Cited by 3 publications

(2 citation statements)

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“…Duodenum-preserving pancreatic head resection is an organ-sparing alternative to pancreaticoduodenectomy for a specific pathology, with fewer early postoperative complications [ 39 ]. Benign and low-grade malignant pancreatic pathologies represent the indications for such a conservative surgical procedure, with chronic pancreatitis as a leading indication; pancreatic malignancies are widely considered a contraindication [ 39 , 40 ]. Duodenum-preserving pancreatic head resection is an exceptional surgical procedure in children compared with adults.…”

Section: Morbidity Of Standard and Organ-sparing Pancreatectomies In ...mentioning

confidence: 99%

“…Studies comparing duodenum-preserving pancreatic head resection with pancreaticoduodenectomies in adults reported better preservation of pancreatic functions and quality of life without increasing the local recurrence rates [ 39 , 40 ]. A meta-analysis performed in adult patients has shown statistically significantly lower rates of new-onset diabetes mellitus and pancreatic exocrine insufficiencies after duodenum-preserving pancreatic head resections, compared with the pancreaticoduodenectomies: 5% vs. 15.7%, and 6.7% vs. 44.3%, respectively.…”

Section: The Burden Of Long-term Pancreatic Function Deficiencies Aft...mentioning

confidence: 99%

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Preservation of Pancreatic Function Should Not Be Disregarded When Performing Pancreatectomies for Pancreatoblastoma in Children

Dumitrascu

2024

Pediatric Reports

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Complete surgical resection in the context of a multimodal approach has been associated with excellent long-term survival in children diagnosed with pancreatoblastoma (PB). Traditionally, curative intent surgery for PB implies standard pancreatic resections such as pancreaticoduodenectomies and distal pancreatectomies with splenectomies, surgical procedures that may lead to significant long-term pancreatic functional deficiencies. Postoperative pancreatic functional deficiencies are particularly interesting to children because they may interfere with their development, considering their long life expectancy and the significant role of pancreatic functions in their nutritional status and growth. Thus, organ-sparing pancreatectomies, such as spleen-preserving distal pancreatectomies and central pancreatectomies, are emerging in specific tumoral pathologies in children. However, data about organ-sparing pancreatectomies’ potential role in curative-intent PB surgery in children are scarce. Based on the literature data, the current review aims to present the early and late outcomes of pancreatectomies in children (including long-term deficiencies and their potential impact on the development and quality of life), particularly for PB, and further explore the potential role of organ-sparing pancreatectomies for PB. Organ-sparing pancreatectomies are associated with better long-term pancreatic functional outcomes, particularly central pancreatectomies, and have a reduced impact on children’s development and quality of life without jeopardizing their oncological safety. The long-term preservation of pancreatic functions should not be disregarded when performing pancreatectomies for PB in children. A subset of patients with PB might benefit from organ-sparing pancreatectomies, particularly from central pancreatectomies, with the same oncological results as standard pancreatectomies but with significantly less impact on long-term functional outcomes.

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Section: Morbidity Of Standard and Organ-sparing Pancreatectomies In ...mentioning

confidence: 99%

Section: The Burden Of Long-term Pancreatic Function Deficiencies Aft...mentioning

confidence: 99%

Preservation of Pancreatic Function Should Not Be Disregarded When Performing Pancreatectomies for Pancreatoblastoma in Children

Dumitrascu

2024

Pediatric Reports

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Prämaligne, zystische Neoplasien und neuroendokrine Tumoren des Pankreaskopfes – Ist die Kausch-Whipple-Resektion eine adäquate Therapie?

Beger

2024

Chirurgie

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ZusammenfassungDas gegenwärtig am häufigsten angewendete operative Verfahren bei symptomatischen, benignen, prämalignen zystischen und neuroendokrinen Tumoren des Pankreaskopfs ist die Whipple-Operation oder pyloruserhaltende Pankreatoduodenektomie (PD); die PD ist jedoch eine Multiorganresektion, bei der pankreatisches und extrapankreatisches Gewebe sowie dessen Funktionen verloren gehen. Die PD ist auch bei benignen Neoplasien mit dem Risiko erheblicher Komplikationen in der frühen postoperativen Phase assoziiert und geht mit einer Krankenhausmortalität von bis zu 5 % einher. Nach Whipple-Operation wird bei 14–20 % der Patienten ein sich neu manifestierender Diabetes mellitus beobachtet, bei 25–45 % tritt eine exokrine Insuffizienz auf, was zu einer nach Resektion benigner Tumoren persistierenden metabolischen Dysfunktion und Beeinträchtigung der Lebensqualität führt. Symptomatische Neoplasien sind Indikation für die operative Therapie. Patienten mit asymptomatischen Pankreastumoren werden gemäß den Kriterien von Surveillance-Protokollen behandelt. Ziel der operativen Therapie bei asymptomatischen Patienten ist entsprechend den Leitlinienkriterien der Abbruch des Surveillance-Programms, bevor sich eine fortgeschrittene Krebserkrankung im Zusammenhang mit der Neoplasie entwickelt. Die Tumorenukleation und duodenumerhaltende Pankreaskopfresektion, entweder total oder partiell, sind parenchymsparende Resektionen bei benignen Neoplasien des Pankreaskopfs. Erste Wahl bei kleinen Tumoren ist die Enukleation; allerdings ist diese mit einem erhöhten Risiko für Pankreasfisteln von Grad B + C nach Pankreas-Hauptgangverletzung assoziiert. Vorteile der duodenumerhaltenden totalen oder partiellen Pankreaskopfresektion sind geringe operationsbedingte Komplikationen, eine Mortalität von < 0,5 % und die Aufrechterhaltung der endo- und exokrinen Pankreasfunktionen. Parenchymsparende Pankreaskopfresektionen sollten die klassischen Whipple-Operationen bei Neoplasien des Pankreaskopfs ablösen.

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Laparoscopic Duodenum and Spleen-Preserving Subtotal or Total Pancreatectomy: A Parenchyma-Sparing Strategy for Main Duct Intraductal Papillary Mucinous Neoplasms (with Video)

Li,

Shi,

Tang

et al. 2024

Ann Surg Oncol

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Background For premalignant main duct intraductal papillary mucinous neoplasms (MD-IPMN), laparoscopic duodenum and spleen-preserving subtotal or total pancreatectomy (LDSP-STP/TP) seems to be a viable option for parenchyma-sparing pancreatectomy. Patients and Methods On the basis of the imaging features, family history, genomic alterations, intraoperative ultrasound examination, and frozen section evaluation, we have proposed patient selection strategies for the LDSP-STP/TP technique for the first time. Additionally, a comprehensive step-by-step overview of this technique has been provided. To date, we have performed five LDSP-STP procedures and one LDSP-TP procedure. Results We successfully performed selective resection of the affected pancreatic parenchyma while preserving the duodenum, common bile duct (CBD), spleen, and splenic artery and vein. The operation time ranged from 295 to 495 min, with blood loss ranging from 100 to 300 mL. Postoperative pathological results revealed low-grade dysplasia in the resected pancreatic samples and margins. The patients resumed eating within 3–5 days after surgery, and all postoperative complications were classified as grade I according to the Clavien–Dindo classification. At the 3-month follow-up, there were no cases of CBD ischemic stenosis, splenic ischemia, or pseudocyst formation observed. For patients who received LDSP-STP, the longitudinal diameter of the remaining pancreatic tail ranged from 2.2 to 4.6 cm, and they demonstrated satisfactory long-term blood glycemic control. Conclusions LDSP-STP/TP demonstrates technical feasibility and safety. It allows for the selective resection of the affected pancreatic parenchyma, thereby minimizing the impact of pancreatic functional impairment. However, it is crucial to validate this technique through long-term prospective observations.

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Long-Term Oncologic Outcome following Duodenum-Preserving Pancreatic Head Resection for Benign Tumors, Cystic Neoplasms, and Neuroendocrine Tumors: Systematic Review and Meta-analysis

Cited by 3 publications

References 86 publications

Preservation of Pancreatic Function Should Not Be Disregarded When Performing Pancreatectomies for Pancreatoblastoma in Children

Preservation of Pancreatic Function Should Not Be Disregarded When Performing Pancreatectomies for Pancreatoblastoma in Children

Prämaligne, zystische Neoplasien und neuroendokrine Tumoren des Pankreaskopfes – Ist die Kausch-Whipple-Resektion eine adäquate Therapie?

Laparoscopic Duodenum and Spleen-Preserving Subtotal or Total Pancreatectomy: A Parenchyma-Sparing Strategy for Main Duct Intraductal Papillary Mucinous Neoplasms (with Video)

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