Pancreatic insufficiency after different resections for benign tumours

Falconi, Massimo; Mantovani, William; Crippa, Stefano; Mascetta, Giuseppe; Salvia, Roberto; Pederzoli, Paolo

doi:10.1002/bjs.5652

Cited by 224 publications

(164 citation statements)

References 36 publications

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“…[41][42][43] Because the probability of malignancy is very low in patients with small MCNs without nodules, lymphadenectomy can be avoided and parenchyma-sparing procedures such as middle pancreatectomy 44 and perhaps enucleations 45,46 should be performed more often, because they decrease the rate of postoperative pancreatic insufficiency and they have been proven to be safe in the treatment of well-selected patients with MCNs. 44,47 If tumors are removed when they are smaller, the expected loss of pancreatic parenchyma should be low, thus decreasing the probability of developing endocrine and exocrine insufficiency during follow-up. 47 When these operations are not feasible because of tumor location and/or size, spleenpreserving or limited DP is a valid alternative.…”

Section: Discussionmentioning

confidence: 99%

“…44,47 If tumors are removed when they are smaller, the expected loss of pancreatic parenchyma should be low, thus decreasing the probability of developing endocrine and exocrine insufficiency during follow-up. 47 When these operations are not feasible because of tumor location and/or size, spleenpreserving or limited DP is a valid alternative. 48,49 In small neoplasms (<5 cm) a minimally invasive approach should be considered.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Mucinous Cystic Neoplasm of the Pancreas is Not an Aggressive Entity

Crippa¹,

Salvia²,

Warshaw³

et al. 2008

Annals of Surgery

425

310

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Objective-Mucinous cystic neoplasms (MCNs) of the pancreas have often been confused with intraductal papillary mucinous neoplasms. We evaluated the clinicopathologic characteristics, prevalence of cancer, and prognosis of a large series of well-characterized MCNs in 2 tertiary centers.Methods-Analysis of 163 patients with resected MCNs, defined by the presence of ovarian stroma and lack of communication with the main pancreatic duct.Results-MCNs were seen mostly in women (95%) and in the distal pancreas (97%); 25% were incidentally discovered. Symptomatic patients typically had mild abdominal pain, but 9% presented with acute pancreatitis. One hundred eighteen patients (72%) had adenoma, 17 (10.5%) borderline tumors, 9 (5.5%) in situ carcinoma, and 19 (12%) invasive carcinoma. Patients with invasive carcinoma were significantly older than those with noninvasive neoplasms (55 vs. 44 years, P = 0.01). Findings associated with malignancy were presence of nodules (P = 0.0001) and diameter ≥60 mm (P = 0.0001). All neoplasms with cancer were either ≥40 mm in size or had nodules. There was no operative mortality and postoperative morbidity was 49%. Median followup was 57 months (range, 4 -233); only patients with invasive carcinoma had recurrence. The 5-year disease-specific survival for noninvasive MCNs was 100%, and for those with invasive cancer, 57%. Conclusions-This PATIENTS AND METHODSThe MGH and UV Institutional Review Boards approved this study. Patients who underwent pancreatic resection between January 1988 and October 2005 for pathologically confirmed MCNs were identified from prospectively collected databases. Both presence of ovarian stroma and lack of communication with the main pancreatic duct were used as criterion to distinguish MCNs from IPMNs. 2,4 In the study period, 567 patients underwent surgery for mucinous tumors of the pancreas (305 MGH and 262 UV). Of these 163 (29%), 102 from UV and 61 from MGH, were determined to have MCNs, whereas the remaining patients had main-duct, branch-duct, or combined IPMNs, or indeterminate mucinous neoplasms. Information including demographics, clinical history, diagnostic work-up, type of surgery, postoperative course, pathology, and long-term follow-up were recorded. Perioperative mortality was defined as in-hospital or 30-day death.Tumors were classified according to the WHO criteria as MCNs with mild dysplasia (adenoma), with moderate dysplasia (borderline neoplasm), with high-grade dysplasia (carcinoma in situ), and MCN with invasive carcinoma. 4 In short, in MCN adenoma, the epithelium shows basally located nuclei with no increase in mitosis. In the borderline MCNs, the epithelium may exhibit papillary projections or crypt-like invagination, some nuclear pseudostratification with crowding and slightly enlarged nuclei. Mitoses can be observed. MCN with noninvasive carcinoma demonstrate high-grade dysplastic epithelial changes. The epithelium often forms papillae and irregular budding, as well as branching with nuclear stratification, severe nuclear a...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mucinous Cystic Neoplasm of the Pancreas is Not an Aggressive Entity

Crippa¹,

Salvia²,

Warshaw³

et al. 2008

Annals of Surgery

425

310

View full text Add to dashboard Cite

show abstract

“…Currently, when performed in high-volume centers, pancreatic typical resections have an acceptable mortality rate (!5%), although the percentage of complications is still significant ranging from 40 to 50% (14,15). Typical pancreatic resections are also associated with a high incidence of exocrine and endocrine insufficiency (16). Risk of longterm pancreatic impairment has increased the use of parenchyma-sparing techniques or atypical resections such as enucleation and middle pancreatectomy that consists of the resection of the central part of the gland.…”

Section: Management Of Localized Diseasementioning

confidence: 99%

GEP–NETS UPDATE: A review on surgery of gastro-entero-pancreatic neuroendocrine tumors

Partelli

Maurizi

Tamburrino

et al. 2014

European Journal of Endocrinology

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The incidence of neuroendocrine tumors (NETs) has increased in the last decades. Surgical treatment encompasses a panel of approaches ranging from conservative procedures to extended surgical resection. Tumor size and localization usually represent the main drivers in the choice of the most appropriate surgical resection. In the presence of small (!2 cm) and asymptomatic nonfunctioning NETs, a conservative treatment is usually recommended. For localized NETs measuring above 2 cm, surgical resection represents the cornerstone in the management of these tumors. As they are relatively biologically indolent, an extended resection is often justified also in the presence of advanced NETs. Surgical options for NET liver metastases range from limited resection up to liver transplantation. Surgical choices for metastatic NETs need to consider the extent of disease, the grade of tumor, and the presence of extra-abdominal disease. Any surgical procedures should always be balanced with the benefit of survival or relieving symptoms and patients' comorbidities.

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“…However, pancreatic resection, even for benign disease, is still associated with very high morbidity and long-term endocrine and exocrine insufficiency risks [21] . This mortality, even reduced to its minimum rate, should be considered very poor for such a benign lesion.…”

Section: Long-term Follow-upmentioning

confidence: 99%

Laparoscopic fenestration of pancreatic serous cystadenoma: Minimally invasive approach for symptomatic benign disease

Dokmak

Aussilhou

Rasoaherinomenjanahary

et al. 2015

WJG

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Serous cystadenoma (SC) is a benign pancreatic cystic tumor. Surgical resection is recommended for symptomatic forms, but laparoscopic fenestration of large symptomatic macrocystic SC was not yet described in the literature. In this study, 3 female patients underwent laparoscopic fenestration for macrocystic SC (12-14 cm). Diagnosis was established via magnetic resonance imaging and endoscopic ultrasound, with intra-cystic dosage of tumors markers (ACE and CA19-9) in 2 patients. All patients were symptomatic and operated on 15-60 mo after diagnosis. Radiological evaluation showed constant cyst growth. Patients were informed about this new surgical modality that can avoid pancreatic resection. The mean operative time was 103 min (70-150 min) with one conversion. The post-operative course was marked by a grade A pancreatic fistula in one patient and was uneventful in the other two. The hospital stay was 3, 10, and 18 d, respectively. The diagnosis of macrocystic SC was histologically-confirmed in all cases. At the last followup (13-26 mo), all patients were symptom-free, and radiological evaluation showed complete disappearance of the cyst. Laparoscopic fenestration, as opposed to resection, should be considered for large symptomatic macrocystic SC, thereby avoiding pancreatic resection morbidity and mortality.

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Pancreatic insufficiency after different resections for benign tumours

Abstract: Different pancreatic resections are associated with different risks of developing long-term pancreatic insufficiency. AR represents the best option in terms of long-term endocrine and exocrine function, although it is associated with more postoperative complications.

Cited by 224 publications

References 36 publications

Mucinous Cystic Neoplasm of the Pancreas is Not an Aggressive Entity

Mucinous Cystic Neoplasm of the Pancreas is Not an Aggressive Entity

GEP–NETS UPDATE: A review on surgery of gastro-entero-pancreatic neuroendocrine tumors

Laparoscopic fenestration of pancreatic serous cystadenoma: Minimally invasive approach for symptomatic benign disease

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