Parenchymal Sparing Resection: Options in Duodenal and Pancreatic Surgery

Marchese, Ugo; Tzedakis, Stylianos; Ali, Einas Abou; Turrini, Olivıer; Delpero, Jean‐Robert; Fuks, David

doi:10.3390/jcm10071479

Cited by 5 publications

(6 citation statements)

References 26 publications

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“…Patients with functional p-NETs usually have small tumors at the time of diagnosis, particularly pancreatic insulinomas, which are benign in 80–90% of patients. Considering the usually small size of tumors at diagnosis, parenchyma-preserving limited pancreatic resection such as pancreatic enucleation should be considered [ 47 , 48 ]. According to guidelines, pancreatic enucleation is an excellent option if the tumor is exophytic or located close to the surface and with a minimum distance of 2–3 mm to the main pancreatic duct [ 49 ].…”

Section: Multimodal Management Of Localized Diseasementioning

confidence: 99%

Multimodal Management of Grade 1 and 2 Pancreatic Neuroendocrine Tumors

Marchese

Gaillard

Pellat

et al. 2022

Cancers

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Pancreatic neuroendocrine tumors (p-NETs) are rare tumors with a recent growing incidence. In the 2017 WHO classification, p-NETs are classified into well-differentiated (i.e., p-NETs grade 1 to 3) and poorly differentiated neuroendocrine carcinomas (i.e., p-NECs). P-NETs G1 and G2 are often non-functioning tumors, of which the prognosis depends on the metastatic status. In the localized setting, p-NETs should be surgically managed, as no benefit for adjuvant chemotherapy has been demonstrated. Parenchymal sparing resection, including both duodenum and pancreas, are safe procedures in selected patients with reduced endocrine and exocrine long-term dysfunction. When the p-NET is benign or borderline malignant, this surgical option is associated with low rates of severe postoperative morbidity and in-hospital mortality. This narrative review offers comments, tips, and tricks from reviewing the available literature on these different options in order to clarify their indications. We also sum up the overall current data on p-NETs G1 and G2 management.

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Section: Multimodal Management Of Localized Diseasementioning

confidence: 99%

Multimodal Management of Grade 1 and 2 Pancreatic Neuroendocrine Tumors

Marchese

Gaillard

Pellat

et al. 2022

Cancers

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“…The indication of CP requires benign or low-grade malignant tumors without histological vascular invasion in the body of the pancreatic neck. In addition, the tumor has a distance between the right cut edge and the common bile duct, while the remaining pancreas is more than 5 cm after the left pancreas is severed 7 – 9 .…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of central pancreatectomy in benign or low-grade malignant pancreatic body lesions: a systematic review and meta-analysis

Bi,

Liu,

Dai

et al. 2023

International Journal of Surgery

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Background: The best approach for treating benign or low-grade malignant lesions localized in the pancreatic neck or body remains debatable. Conventional pancreatoduodenectomy and distal pancreatectomy (DP) are associated with a risk of impairment of pancreatic function at long-term follow-up. With advances in technology and surgical skills, the use of central pancreatectomy (CP) has gradually increased. Objectives: The objective was to compare the safety, feasibility, and short-term and long-term clinical benefits of CP and DP in matched cases. Methods: The PubMed, MEDLINE, Web of Science, Cochrane, and EMBASE databases were systematically searched to identify studies published from database inception to February 2022 that compared CP and DP. This meta-analysis was performed using R software. Results: Twenty-six studies matched the selection criteria, including 774 CP and 1713 DP cases. CP was significantly associated with longer operative time ( P <0.0001), less blood loss ( P <0.01), overall and clinically relevant pancreatic fistula ( P <0.0001), postoperative hemorrhage ( P <0.0001), reoperation ( P =0.0196), delayed gastric emptying ( P =0.0096), increased hospital stay ( P =0.0002), intra-abdominal abscess or effusion ( P =0.0161), higher morbidity ( P <0.0001) and severe morbidity ( P <0.0001) but with a significantly lower incidence of overall endocrine and exocrine insufficiency ( P <0.01), and new-onset and worsening diabetes mellitus ( P <0.0001) than DP. Conclusions: CP should be considered as an alternative to DP in selected cases such as without pancreatic disease, length of the residual distal pancreas is more than 5 cm, branch-duct intraductal papillary mucinous neoplasms, and a low risk of postoperative pancreatic fistula after adequate evaluation.

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“…[1][2][3] Small, benign insulinomas are readily curable by parenchymal-sparing pancreatic resection or enucleation, preserving the pancreatic parenchyma to the greatest possible extent and avoiding long-term pancreatic insufficiency. [4][5][6][7] Patients typically have satisfactory clinical outcomes. [4,8,9] However, occasions exist where a more extensive procedure is required when enucleation is difficult to perform.…”

Section: Introductionmentioning

confidence: 99%

Mind the tributary of the canal: Are stents necessary for insulinoma enucleation in proximity to a prominent Duct of Santorini: A case report and literature review

Liu

Zou

et al. 2022

Medicine

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Rationale: We describe a case of insulinoma located extremely close to the accessory pancreatic duct (APD), but away from the main pancreatic duct (MPD). Previous studies showed insulinoma enucleation is a safe procedure for small benign tumors >3 mm distant from the MPD. However, in this case enucleation of the tumor led to unanticipated APD injury and grade B post-operative pancreatic fistula (POPF). We provide detailed records of clinical management and argue that enucleation of tumors near APD needs to be carefully weighed.Patient concerns: The patient experienced a sudden increase of abdominal drain fluid and prolonged drainage time after a regular insulinoma enucleation surgery.

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Parenchymal Sparing Resection: Options in Duodenal and Pancreatic Surgery

Cited by 5 publications

References 26 publications

Multimodal Management of Grade 1 and 2 Pancreatic Neuroendocrine Tumors

Multimodal Management of Grade 1 and 2 Pancreatic Neuroendocrine Tumors

Effectiveness and safety of central pancreatectomy in benign or low-grade malignant pancreatic body lesions: a systematic review and meta-analysis

Mind the tributary of the canal: Are stents necessary for insulinoma enucleation in proximity to a prominent Duct of Santorini: A case report and literature review

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