Middle Segment Pancreatectomy: A Useful Tool in the Management of Pancreatic Neoplasms

Bassi, Claudio

doi:10.1007/s11605-007-0179-y

Cited by 17 publications

(8 citation statements)

References 33 publications

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“…CP is an uncommon pancreatic resection (<3% of all pancreatic resections) even at high-volume centers [4, 6]. Although similar procedures have been described long ago for chronic pancreatitis and pancreatic trauma [15, 16], the first formal CP for a neoplasm was performed by Dagradi and Serio [17] to remove a benign insulinoma.…”

Section: Discussionmentioning

confidence: 99%

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Is Central Pancreatectomy Truly Recommendable? A 9-Year Single-Center Experience

Qian

Qiu

et al. 2017

Dig Surg

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Aims: To compare the short- and long-term outcomes in patients with pancreatic benign or borderline neoplasm who underwent central pancreatectomy (CP) and distal pancreatectomy (DP). Methods: The inclusion criteria were as follows: (1) single benign or low-grade malignant tumor; (2) tumor conﬁned to the pancreatic neck or proximal body; and (3) tumor amenable to either CP or DP. Short and long-term outcomes, including complications, pancreatic exocrine and endocrine function, and quality of life (QoL) were analyzed retrospectively. Results: Sixteen patients who underwent CP and 26 patients who underwent DP were included. The median follow-up period was 53 months (range 21–117 months). Patients undergoing CP were significantly more likely to experience complications (68.7 vs. 23%, p = 0.003) especially grade B/C postoperative pancreatic fistula (62.5 vs. 23%, p = 0.011) than those undergoing DP. During the long-term follow-up, 2 patients in the DP group developed new-onset diabetes mellitus, but no patient in CP group developed this condition (8 vs. 0%, p = 0.382). Evidence of exocrine insufficiency, including severe diarrhea or steatorrhea, was not observed in either group. Both groups were equally satisfied with the overall health status and overall QoL. Conclusion: CP is associated with excellent pancreatic function but a significantly increased postoperative morbidity and risk compared to DP. Therefore, the indication of CP should be chosen strictly.

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Section: Discussionmentioning

confidence: 99%

“…The central point of the argument is the weighing of the benefit of glandular preservation versus the disadvantage of managing 2 cut surfaces and corresponding high potential risk. Therefore, CP has been advocated in some centers [4-6], while its clinical value is considered to be overstated by other authors [7-9]. …”

Section: Introductionmentioning

confidence: 99%

Is Central Pancreatectomy Truly Recommendable? A 9-Year Single-Center Experience

Qian

Qiu

et al. 2017

Dig Surg

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“…29 Higher rates of pancreatic fistula should be anticipated in central pancreatectomy, which range from 20% to 63% among specialized centers. [30][31][32][33][34] It is presumed that these higher rates are due to the creation of two pancreatic remnants in this procedure and, thus, two potential sites for fistula formation. However, valid conclusions in this resection modality will require additional investigations and larger operative series.…”

Section: Clinical Coursementioning

confidence: 99%

Prevention and Management of Pancreatic Fistula

Callery

Pratt

Vollmer

2009

Journal of Gastrointestinal Surgery

116

105

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Despite significant improvements in the safety and efficacy of pancreatic surgery, post-operative pancreatic fistulae remain an unsolved dilemma. These occur when the transected pancreatic gland, pancreatic-enteric anastomosis, or both, leak rendering the patient at significant risk. They are especially important today since indications for resection (IPMN, carcinoma) continue to increase. This review considers definitions and classifications of pancreatic fistulae, risk factors, preventative approaches and offers management strategies for when they do occur. Key citations from the past seventeen years have been scrutinized, and together with personal experience, provide the basis for this review.

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“…The distal stump of the pancreas is mobilized and reconstruction is accomplished with a pancreaticojejunostomy and Roux-en-Y anastomosis. Fistula rates between 8 and 63% are reported for middle pancreatic resection, which is explained by the different underlying pathologies, with lowest rates achieved in CP patients [ 37 , 38 ].…”

Section: Surgical Therapy Of Chronic Pancreatitismentioning

confidence: 99%

The Pancreas: Causes for Malabsorption

Hackert¹,

Schütte²,

Malfertheiner³

2014

Visc Med

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Background: The pancreas has a central function in digestion and glucose homeostasis. With regard to the exocrine function, which is responsible for the digestion and absorption of nutrients and vitamins, the most important disturbances of these physiological processes are based on deficiencies in enzyme production and secretion, either due to impaired excretion caused by obstruction of the pancreatic duct or due to loss of pancreatic tissue. Both conditions result in maldigestion, malabsorption, and malnutrition. Methods: Systematic literature review. Results: Symptoms associated with pancreatic exocrine failure are gastrointestinal discomfort, steatorrhea, and weight loss. Pancreatic exocrine insufficiency caused by ductal obstruction occurs in chronic pancreatitis or with neoplasia of the pancreatic head. Loss of functional parenchyma can be caused either by chronic pancreatitis resulting in fibrotic replacement of the destroyed parenchyma or by a postoperative state of pancreatic resection. Conclusion: In patients with chronic pancreatitis, a stage-adapted and timely therapy including conservative as well as surgical measures is essential to prevent functional deterioration and to preserve residual function. In the case of pancreatic resection for chronic pancreatitis, this can be achieved with modern organ-sparing surgery such as the duodenum-preserving pancreatic head resection. In patients requiring more extended pancreatic resections and even total duodenopancreatectomy, regardless of the underlying indication, adequate enzyme replacement and monitoring of the nutritional status is critical to prevent impairment of quality of life as well as detrimental malnutrition in the long term.

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Middle Segment Pancreatectomy: A Useful Tool in the Management of Pancreatic Neoplasms

Cited by 17 publications

References 33 publications

Is Central Pancreatectomy Truly Recommendable? A 9-Year Single-Center Experience

Is Central Pancreatectomy Truly Recommendable? A 9-Year Single-Center Experience

Prevention and Management of Pancreatic Fistula

The Pancreas: Causes for Malabsorption

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