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HPB : the Official Journal of the... Feb 2022Central pancreatectomy is usually performed to excise lesions of the neck or proximal body of the pancreas. In the last decade, thanks to the advent of novel... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Central pancreatectomy is usually performed to excise lesions of the neck or proximal body of the pancreas. In the last decade, thanks to the advent of novel technologies, surgeons have started to perform this procedure robotically. This review aims to appraise the results and outcomes of robotic central pancreatectomies (RCP) through a systematic review and meta-analysis.
METHODS
A systematic search of MEDLINE, Embase, and Web Of Science identified studies reporting outcomes of RCP. Pooled prevalence rates of postoperative complications and mortality were computed using random-effect modelling.
RESULTS
Thirteen series involving 265 patients were included. In all cases but one, RCP was performed to excise benign or low-grade tumours. Clinically relevant post-operative pancreatic fistula (POPF) occurred in 42.3% of patients. While overall complications were reported in 57.5% of patients, only 9.4% had a Clavien-Dindo score ≥ III. Re-operation was necessary in 0.7% of the patients. New-onset diabetes occurred postoperatively in 0.3% of patients and negligible mortality and open conversion rates were observed.
CONCLUSION
RCP is safe and associated with low perioperative mortality and well preserved postoperative pancreatic function, although burdened by high overall morbidity and POPF rates.
Topics: Humans; Pancreas; Pancreatectomy; Pancreatic Fistula; Pancreatic Neoplasms; Postoperative Complications; Robotic Surgical Procedures
PubMed: 34625342
DOI: 10.1016/j.hpb.2021.09.014 -
Current Treatment Options in Oncology Feb 2021Pancreatic neuroendocrine tumours (PNETs) are a rare and heterogeneous group of tumours with various clinical manifestations and biological behaviours. They represent... (Review)
Review
Pancreatic neuroendocrine tumours (PNETs) are a rare and heterogeneous group of tumours with various clinical manifestations and biological behaviours. They represent approximately 2-4% of all pancreatic tumours, with an incidence of 2-3 cases per million people. PNETs are classified clinically as non-functional or functional, and pancreatic resection is recommended for lesions greater than 2 cm. The surgical approach can involve "typical" and "atypical" resections depending on the number, size and location of the tumour. Typical resections include pancreaticoduodenectomy, distal pancreatectomy enucleation and, rarely, total pancreatectomy. Atypical resections comprise central pancreatectomies or enucleations. Minimally invasive pancreatic resection has been proven to be technically feasible and safe in high-volume and specialized centres with highly skilled laparoscopic surgeons, with consolidated benefits for patients in the postoperative course. However, open and minimally invasive pancreatic surgery remains to have a high rate of complications; there is no specific technical contraindication to minimally invasive pancreatic surgery, but an appropriate patient selection is crucial to obtain satisfactory clinical and oncological outcomes.
Topics: Clinical Decision-Making; Combined Modality Therapy; Cost-Benefit Analysis; Disease Management; Health Care Costs; Humans; Laparoscopy; Minimally Invasive Surgical Procedures; Neoplasm Staging; Neuroendocrine Tumors; Pancreatectomy; Pancreatic Neoplasms; Postoperative Complications; Prognosis; Treatment Outcome
PubMed: 33641016
DOI: 10.1007/s11864-021-00824-5 -
HPB : the Official Journal of the... Dec 2022Among patients with distant metastatic melanoma, the site of metastases is the most significant predictor of survival and visceral-nonpulmonary metastases hold the... (Review)
Review
BACKGROUND
Among patients with distant metastatic melanoma, the site of metastases is the most significant predictor of survival and visceral-nonpulmonary metastases hold the highest risk of poor outcomes. However, studies demonstrate that a significant percentage of patients may be considered candidates for resection with improved survival over nonsurgical therapeutic modalities. We aimed at analyzing the results of resection in patients with melanoma metastasis to the pancreas by assessing the available evidence.
METHODS
The PubMed/MEDLINE, WoS, and Embase electronic databases were systematically searched for articles reporting on the surgical treatment of pancreatic metastases from melanoma. Relevant data from included studies were assessed and analyzed. Overall survival was the primary endpoint of interest. Surgical details and oncological outcomes were also appraised.
RESULTS
A total of 109 patients treated surgically for pancreatic metastases were included across 72 articles and considered for data extraction. Overall, patients had a mean age of 51.8 years at diagnosis of pancreatic disease. The cumulative survival was 71%, 38%, and 26% at 1, 3 and 5 years after pancreatectomy, with an estimated median survival of 24 months. Incomplete resection and concomitant extrapancreatic metastasis were the only factors which significantly affected survival. Patients in whom the pancreas was the only metastatic site who received curative resection exhibited significantly longer survival, with a 1-year, 3-year, and 5-year survival rates of 76%, 43%, and 41%, respectively.
CONCLUSION
Within the limitations of a review of non-randomized reports, curative surgical resection confers a survival benefit in carefully selected patients with pancreatic dissemination of melanoma.
Topics: Humans; Middle Aged; Melanoma; Pancreas; Pancreatectomy; Pancreatic Neoplasms; Survival Rate
PubMed: 36167766
DOI: 10.1016/j.hpb.2022.08.012 -
Journal of Investigative Surgery : the... Apr 2022several pancreatectomy techniques in rats have been described and utilized for research concerning the pancreas endocrine and exocrine functions. However, we did not...
INTRODUCTION
several pancreatectomy techniques in rats have been described and utilized for research concerning the pancreas endocrine and exocrine functions. However, we did not find a description of any kind of laparoscopic pancreatectomy in rats in the consulted databases. The objective of this study is to describe a laparoscopic splenic lobe pancreatectomy in rats.
METHODS
ten Wistars rats weighting more then 300 g were operated for standardizing the laparoscopic pancreatosplenectomy technique, aided by previous descriptions of laparoscopic splenectomy and open pancreatectomy in rats. Adjustments have been progressively adopted for technical refinement.
RESULTS
In five animals a low-cost rat laparoscopic set was used. In other five animals we used a standard laparoscopic set. Three rats died early due to different causes: transection of the gastroesophageal junction, hemorrhagic shock and inadvertent colonic injury. The postoperative period of the other seven rats was uneventful until the seventh postoperative day.
DISCUSSION
laparoscopic distal pancreatectomy and splenectomy in rats is feasible and safe, even with a low-cost set, in which the results were alike the standard laparoscopic set.
Topics: Animals; Laparoscopy; Models, Theoretical; Pancreatectomy; Pancreatic Neoplasms; Rats; Rats, Wistar; Splenectomy
PubMed: 34278920
DOI: 10.1080/08941939.2021.1946220 -
HPB : the Official Journal of the... Sep 2023Postoperative pancreatic fistula (POPF) represents one of the most severe complications following pancreatic surgery. Despite being a leading cause of morbidity and... (Review)
Review
OBJECTIVES
Postoperative pancreatic fistula (POPF) represents one of the most severe complications following pancreatic surgery. Despite being a leading cause of morbidity and mortality, its pathophysiology is poorly understood. In recent years, there has been growing evidence to support the role of postoperative or post-pancreatectomy acute pancreatitis (PPAP) in the development of POPF. This article reviews the contemporary literature on POPF pathophysiology, risk factors, and prevention strategies.
METHODS
A literature search was conducted using electronic databases, including Ovid Medline, EMBASE, and Cochrane Library, to retrieve relevant literature published between 2005 and 2023. A narrative review was planned from the outset.
RESULTS
A total of 104 studies fulfilled criteria for inclusion. Forty-three studies reported on technical factors predisposing to POPF, including resection and reconstruction technique and adjuncts for anastomotic reinforcement. Thirty-four studies reported on POPF pathophysiology. There is compelling evidence to suggest that PPAP plays a critical role in the development of POPF. The acinar component of the remnant pancreas should be regarded as an intrinsic risk factor; meanwhile, operative stress, remnant hypoperfusion, and inflammation represent common mechanisms for acinar cell injury.
CONCLUSIONS
The evidence base for PPAP and POPF is evolving. Future POPF prevention strategies should look beyond anastomotic reinforcement and target underlying mechanisms of PPAP development.
Topics: Humans; Pancreatic Fistula; Pancreatitis; Acute Disease; Pancreas; Pancreatectomy; Risk Factors; Postoperative Complications; Retrospective Studies; Pancreaticoduodenectomy
PubMed: 37301633
DOI: 10.1016/j.hpb.2023.05.007 -
Annali Italiani Di Chirurgia 2022To analyze the minimally invasive surgical maneuvers currently performed to remove pancreatic tail, with or without preservation of the spleen, for benign and borderline...
AIM
To analyze the minimally invasive surgical maneuvers currently performed to remove pancreatic tail, with or without preservation of the spleen, for benign and borderline malignant neoplasms.
MATERIAL AND METHODS
We described operative steps and technical pitfalls encountered during laparoscopic and robotic distal pancreatectomy. The methodology of research focused on recruitment of evidence-based surgical strategies and critical analysis of modern minimally invasive techniques.
RESULTS
Laparoscopic and robotic distal pancreatectomy have gradually accepted by pancreatic surgeons and clinical evidences document its growing interest. The choice of patient positioning, port placement, surgical dissection and operative techniques used for pancreatic parenchymal transection is not codified and changes according to personal preference. The technical variability in minimally invasive approach to pancreatic surgery strongly depends depends on surgeon's training and to limited application of these procedures in single institutions.
CONCLUSIONS
Pancreatic surgeons worldwide accept laparoscopic and robotic distal pancreatectomy but the best intraoperative praxis is not defined in clinical routine. To date, the pancreatic resection adopts hybrid techniques and the conduction of minimally invasive resection depends to surgeon's experience, patient body habitus and location of pancreatic lesion. Although several technical variations have described, no standardization of the operative minimally invasive surgical method is convincingly built.
KEY WORDS
Laparoscopy, Minimally invasive surgery, Pancreas, Robotic pancreatectomy.
Topics: Humans; Laparoscopy; Pancreatectomy; Pancreatic Neoplasms; Reference Standards; Robotic Surgical Procedures
PubMed: 34645715
DOI: No ID Found -
Vascular Oct 2023Pancreatic body and tail tumors account for one-third of all pancreatic tumors and can be diagnosed later than pancreatic head tumors because they present symptoms much...
OBJECTIVES
Pancreatic body and tail tumors account for one-third of all pancreatic tumors and can be diagnosed later than pancreatic head tumors because they present symptoms much later. When analyzed, most of them are generally unresectable because they are invaded into adjacent organs and vascular structures. We aimed to present our cases of vascular resection and anastomosis, where isolated tumor resection cannot be performed due to invasion of adjacent vascular structures.
METHODS
Between January 2019 and January 2021, the files of eight patients who had one or more vascular invasions due to the pancreatic body and tail tumor and therefore underwent vascular resection in addition to pancreatectomy were accessed.
RESULTS
Portal vein and hepatic artery repair were performed in all eight patients. Superior mesenteric artery anastomosis was performed in four patients, inferior vena cava repair was performed in two patients, and renal vein anastomosis was performed in two patients. Primary end-to-end repair, Dacron graft, ring-enforced polytetrafluoroethylene graft, and saphenous vein graft techniques were used during vascular interventions.
CONCLUSIONS
We wanted to share our experience with the resection of vascular structures and anastomosis techniques. We believe that the indications of tumor surgery can be improved and redesigned by performing more routinely vascular resections and reconstructions in the future.
Topics: Humans; Pancreatectomy; Pancreas; Pancreatic Neoplasms; Portal Vein; Vascular Surgical Procedures; Anastomosis, Surgical
PubMed: 35477336
DOI: 10.1177/17085381221091053 -
HPB : the Official Journal of the... Dec 2021This paper reports our experience of the perioperative management of patients with sporadic, non-malignant, pancreatic insulinoma.
BACKGROUND
This paper reports our experience of the perioperative management of patients with sporadic, non-malignant, pancreatic insulinoma.
METHODS
A retrospective monocentric cohort study was performed from January 1989 to July 2019, including all the patients who had been operated on for pancreatic insulinoma. The preoperative work-up, surgical management, and postoperative outcome were analyzed.
RESULTS
Eighty patients underwent surgery for sporadic pancreatic insulinoma, 50 of which were female (62%), with a median age of 50 (36-70) years. Preoperatively, the tumors were localized in 76 patients (95%). Computed tomography (CT) and magnetic resonance imaging allowed exact preoperative tumor localization in 76% of the patients (64-85 and 58-88 patients, respectively), increasing to 96% when endoscopic ultrasonography was performed. Forty-one parenchyma-sparing pancreatectomies (PSP) (including enucleation, caudal pancreatectomy, and uncinate process resection) and 39 pancreatic resections were performed. The mortality rate was 6% (n = 5), with a morbidity rate of 72%, including 24 severe complications (30%) and 35 pancreatic fistulas (44%). No differences were found between formal pancreatectomy and PSP in terms of postoperative outcome procedures. The surgery was curative in all the patients.
CONCLUSION
CT used in combination with endoscopic ultrasonography allows accurate localization of insulinomas in almost all patients. When possible, a parenchyma-sparing pancreatectomy should be proposed as the first-line surgical strategy.
Topics: Aged; Cohort Studies; Female; Humans; Insulinoma; Middle Aged; Pancreatectomy; Pancreatic Neoplasms; Retrospective Studies; Treatment Outcome
PubMed: 33975801
DOI: 10.1016/j.hpb.2021.04.013 -
Pancreatology : Official Journal of the... Jun 2022Chronic pancreatitis results in permanent parenchymal destruction of the pancreas gland leading to anatomical and physiological consequences for patients. Surgical... (Review)
Review
Chronic pancreatitis results in permanent parenchymal destruction of the pancreas gland leading to anatomical and physiological consequences for patients. Surgical management varies, and some patients require total pancreatectomy with autologous islet cell transplantation (TPIAT). Patients undergoing TPIAT require complex and diligent management after surgery. This encompasses the management of glucose control (endocrine function of the pancreas) and supplementing loss of exocrine function of the pancreas with digestive enzymes. Other areas of management include optimizing pain relief while reducing narcotic usage, providing antimicrobial prophylaxis, and reducing loss of islet cells by improving its integrity through anticoagulation and use of anti-inflammatory agents. Each aspect of care is unique to this population. However, comprehensive reviews on its pharmacological management are scarce. This review will discuss the available literature to date surrounding all aspects of pharmacological management of patients undergoing TPIAT.
Topics: Humans; Islets of Langerhans; Islets of Langerhans Transplantation; Pancreatectomy; Pancreatitis, Chronic; Transplantation, Autologous; Treatment Outcome
PubMed: 35490122
DOI: 10.1016/j.pan.2022.04.009 -
Endocrine Journal Nov 2023Residual pancreatic endocrine function is important for maintaining metabolic status after pancreatectomy and is closely related to patient nutritional status and...
Residual pancreatic endocrine function is important for maintaining metabolic status after pancreatectomy and is closely related to patient nutritional status and prognosis. In contrast to insulin secretion, the significance of glucagon secretion following pancreatectomy remains unclear. In this study, we assessed the changes in pancreatic glucagon secretion during pancreatectomy to determine their pathophysiological significance. We evaluated glucagon and insulin secretion using a liquid meal tolerance test before and after pancreatectomy in patients scheduled to undergo pancreaticoduodenectomy (PD) or distal pancreatectomy (DP). After pancreatectomy, fasting plasma glucagon levels were significantly decreased in both the PD (n = 10) and DP (n = 5) groups (PD: from 18.4 to 10.5 pg/mL, p = 0.037; DP: from 21.0 to 12.1 pg/mL, p = 0.043), whereas postprandial plasma glucagon levels were not changed. In the liquid meal tolerance test after pancreatectomy, 60-min plasma glucagon levels and the area under the curve (AUC) for 0-120 min of PD were significantly higher than those for DP (60-min plasma glucagon: PD 49.0 vs. DP 21.7 pg/mL, p = 0.040; AUC: PD 4,749 vs. DP 3,564 μg min/mL, p = 0.028). Postoperative plasma glucose, serum insulin, and serum C-peptide levels during the liquid meal tolerance test were not significantly different between the two groups. Although fasting plasma glucagon levels decreased, postprandial glucagon responses were maintained after both PD and DP. The difference in residual meal-stimulated glucagon response between PD and DP suggests that a relative excess of postprandial glucagon is involved in the postoperative nutritional status after PD through its impact on systemic metabolic status.
Topics: Humans; Glucagon; Pancreatectomy; Blood Glucose; Pancreas; Insulin Secretion; Insulin; Postprandial Period
PubMed: 37704414
DOI: 10.1507/endocrj.EJ23-0032