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World Journal of Gastroenterology Jul 2019Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage... (Review)
Review
Postoperative pancreatic fistula (POPF) is one of the most severe complications after pancreatic surgeries. POPF develops as a consequence of pancreatic juice leakage from a surgically exfoliated surface and/or anastomotic stump, which sometimes cause intraperitoneal abscesses and subsequent lethal hemorrhage. In recent years, various surgical and perioperative attempts have been examined to reduce the incidence of POPF. We reviewed several well-designed studies addressing POPF-related factors, such as reconstruction methods, anastomotic techniques, stent usage, prophylactic intra-abdominal drainage, and somatostatin analogs, after pancreaticoduodenectomy and distal pancreatectomy, and we assessed the current status of POPF. In addition, we also discussed the current status of POPF in minimally invasive surgeries, laparoscopic surgeries, and robotic surgeries.
Topics: Drainage; Humans; Laparoscopy; Pancreas; Pancreatectomy; Pancreatic Fistula; Pancreatic Juice; Pancreatic Neoplasms; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative Care; Postoperative Complications; Risk Factors; Robotic Surgical Procedures; Somatostatin; Stents; Treatment Outcome
PubMed: 31391768
DOI: 10.3748/wjg.v25.i28.3722 -
Life (Basel, Switzerland) Jun 2023Pancreatectomy, including pancreaticoduodenectomy (PD), as well as central pancreatectomy (CP), distal pancreatectomy (DP) and total/subtotal pancreatectomy, is a major,...
Pancreatectomy, including pancreaticoduodenectomy (PD), as well as central pancreatectomy (CP), distal pancreatectomy (DP) and total/subtotal pancreatectomy, is a major, complex and difficult surgical procedure performed for various benign and malignant pancreatic diseases: from chronic pancreatitis, through benign cystic tumors and neuroendocrine neoplasms to malignant neoplasms, including pancreatic ductal adenocarcinoma (PDAC) [...].
PubMed: 37374182
DOI: 10.3390/life13061400 -
World Journal of Surgical Oncology Feb 2021Pancreatic resections are complex and technically challenging surgical procedures. They often come with potential limitations to high-volume centers. Distal... (Review)
Review
BACKGROUND
Pancreatic resections are complex and technically challenging surgical procedures. They often come with potential limitations to high-volume centers. Distal pancreatectomy is a relatively simple procedure in most cases. It facilitates the development of up-to-date minimally invasive surgical procedures in pancreatic surgery including laparoscopic distal pancreatectomy and robot-assisted distal pancreatectomy.
MAIN BODY
To obtain a desirable long-term prognosis, R0 resection and adequate lymphadenectomy are crucial to the surgical management of pancreatic cancer, and they demand standard procedure and multi-visceral resection if necessary. With respect to combined organ resection, progress has been made in evaluating and determining when and how to preserve the spleen. The postoperative pancreatic fistula, however, remains the most significant complication of distal pancreatectomy, with a rather high incidence. In addition, a safe closure of the pancreatic remnant persists as an area of concern. Therefore, much efforts that focus on the management of the pancreatic stump have been made to mitigate morbidity.
CONCLUSION
This review summarized the historical development of the techniques for pancreatic resections in recent years and describes the progress. The review eventually looked into the controversies regarding distal pancreatectomy for tumors in the body and tail of the pancreas.
Topics: Humans; Laparoscopy; Pancreas; Pancreatectomy; Pancreatic Fistula; Pancreatic Neoplasms; Prognosis
PubMed: 33588845
DOI: 10.1186/s12957-021-02159-9 -
Gland Surgery Mar 2021Splenectomy or distal pancreatectomy (DP) is sometimes performed for optimal cytoreduction in advanced ovarian cancer (AOC). In particular, it is considered to remove... (Review)
Review
Splenectomy or distal pancreatectomy (DP) is sometimes performed for optimal cytoreduction in advanced ovarian cancer (AOC). In particular, it is considered to remove tumors involving the splenic hilum or the capsule of the spleen to secure tumor-free margins sufficiently. For splenectomy, the gastro-splenic ligament is opened, and the short gastric vessels are dissected. After the splenocolic ligament and splenic flexure of the colon are transected, the peritoneal attachments, including the splenorenal and splenophrenic ligaments, are divided to mobilize the spleen, and then the splenic artery and vein are identified and ligated separately. If DP is needed for resection of tumors, a linear cutting stapler is used to remove the tail of the pancreas, and suture reinforcement with 2-0 or 3-0 prolene on the cut section of the pancreas is performed to prevent postoperative pancreatic fistula (POPF). Immunization with a polyvalent pneumococcal vaccine is required after splenectomy to avoid overwhelming post-splenectomy infection (OPSI) caused by , , and . If POPF occurs after splenectomy or DP, continued drainage with close monitoring is needed with the administration of board spectrum antibiotics in grade A or B POPF according to the criteria of the International Study Group of Pancreatic Fistula (ISGPF). In contrast, grade C POPF requires aggressive management using nothing by mouth, total parenteral nutrition, and somatostatin analogs, and sometimes reoperation if deteriorating signs such as sepsis and organ dysfunction. Thus, the effort for preserving pancreatic tail is needed to reduce hospitalization and the risk of POPF despite the minimal impact of DP on the success rate of optimal cytoreduction.
PubMed: 33842268
DOI: 10.21037/gs-2019-ursoc-09 -
Frontiers in Oncology 2022
PubMed: 36505812
DOI: 10.3389/fonc.2022.1024928 -
Przeglad Gastroenterologiczny 2022Diagnosis of pancreatic cancer is challenging in the initial phases because its progression is rapid. The pancreatic tail and body roughly accounts for 20-30% of all... (Review)
Review
Diagnosis of pancreatic cancer is challenging in the initial phases because its progression is rapid. The pancreatic tail and body roughly accounts for 20-30% of all cancerous cases. The standard treatment for symptomatic benign, malignant, and premalignant diseases of the pancreatic tail and body is distal pancreatectomy. This technique has been modified over the years to fit certain indications, with the goal of enhancing post-operative results as well as reducing patient trauma. In cases of a premalignant and symptomatic benign condition, the spleen must be preserved either using Kimura's splenic vessel preservation technique or Warshaw's splenic vessel resection technique. A better long-term prognosis is ensured by regional lymph node dissection and radical R0 resection. Radical antegrade modular pancreatosplenectomy was proposed to tackle the shortcomings of traditional surgery for pancreatic tail and body cancer. In this review, study techniques and results of laparoscopic distal pancreatectomy for malignant and benign pancreatic ailments were described with the intention of providing knowledge on various suitable techniques reported for pancreatic cancer treatment. Furthermore, this study will serve as a ready reckoner for surgeons and could serve to boost their confidence levels during surgery by avoiding confusion on the selection of suitable for the pancreatic diseases diagnosed.
PubMed: 35664025
DOI: 10.5114/pg.2021.109625 -
BMJ Case Reports Oct 2020A 60-year-old woman was investigated for abdominal pain and increasing asthenia. Abdominal CT revealed a 25 mm hypodense cystic lesion in the tail of the pancreas. MRI...
A 60-year-old woman was investigated for abdominal pain and increasing asthenia. Abdominal CT revealed a 25 mm hypodense cystic lesion in the tail of the pancreas. MRI showed a multiloculated cystic lesion, T1-hypointense and T2-hyperintense lesion, without wall enhancement. Endoscopic ultrasound detected a 25 mm multi-loculated cystic lesion, with regular margin and without pancreatic duct communication. Diagnosis of pancreatic mucinous cystadenoma was discussed and the patient was referred to surgery. She underwent distal pancreatectomy with spleen preservation. Pathological examination revealed the diagnosis of pancreatic mesothelial cyst. Histologically, the cyst was multiloculated, lined by cuboidal epithelium, ovoid nuclei and amphophilic cytoplasm, without mucin deposition or cytological atypia. Immunohistochemistry examination revealed positive staining for cytokeratin 5/6, vimentin and calretinin. At 1-year follow-up, she is in her usual health, without any symptoms.
Topics: Cystadenoma, Mucinous; Diagnosis, Differential; Endosonography; Epithelium; Female; Humans; Immunohistochemistry; Magnetic Resonance Imaging; Middle Aged; Pancreas; Pancreatectomy; Pancreatic Cyst; Pancreatic Neoplasms; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 33028569
DOI: 10.1136/bcr-2020-236255 -
Annals of Gastroenterological Surgery Jul 2021Robotic surgery has emerged as an alternative to laparoscopic surgery and it has also been applied to pancreatectomy. With the increase in the number of robotic... (Review)
Review
Robotic surgery has emerged as an alternative to laparoscopic surgery and it has also been applied to pancreatectomy. With the increase in the number of robotic pancreatectomies, several studies comparing robotic pancreatectomy and conventional open or laparoscopic pancreatectomy have been published. However, the use of robotic pancreatectomy remains controversial. In this review, we aimed to provide a comprehensive overview of the current status of robotic pancreatectomy. Various aspects of robotic pancreatectomy and conventional open or laparoscopic pancreatectomy are compared, including the benefits, limitations, oncological efficacy, learning curves, and costs. Both robotic pancreatoduodenectomy and distal pancreatectomy have favorable or comparable outcomes to conventional procedures, and robotic pancreatectomy has the potential to be an alternative to open or laparoscopic procedures. However, there are still several disadvantages to robotic platforms, such as prolonged operative duration and the high cost of the procedure. These disadvantages will be improved by developing instruments, overcoming the learning curve, and increasing the number of robotic pancreatectomies. In addition, robotic pancreatectomy is still in the introductory period in most centers and should only be used in accordance with strict indications.
PubMed: 34337295
DOI: 10.1002/ags3.12446 -
Asian Journal of Surgery Oct 2023Patients with locally advanced pancreatic body/tail tumors, gastric cancer, or colon cancer often have contiguous organ involvement requiring extensive pancreatic...
PURPOSE
Patients with locally advanced pancreatic body/tail tumors, gastric cancer, or colon cancer often have contiguous organ involvement requiring extensive pancreatic resection. This study was performed to compare surgical complications and the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) between distal pancreatectomy (DP) with extended organ resection and standard DP.
METHODS
In total, 128 patients who underwent DP from January 2012 to January 2021 were retrospectively reviewed. Extended DP was defined according to the International Study Group of Pancreatic Surgery definition.
RESULTS
Of the 128 patients, 62 (48.4%) underwent extended DP and 66 (51.6%) underwent DP. Blood loss was greater (p < 0.001), the incidence of major complications was higher (p = 0.032), and the hospital stay was longer (p = 0.002) in the extended DP group than in the DP group. There were no differences in the incidence of CR-POPF, the readmission rate, or the need for postoperative intervention drainage. Univariate and multivariate analyses showed that extended DP was not a risk factor for CR-POPF or major complications.
CONCLUSION
Extended DP can be performed with comparable CR-POPF occurrence and mortality but increased morbidity when compared with standard DP.
Topics: Humans; Pancreatectomy; Retrospective Studies; Pancreas; Pancreatic Fistula; Pancreatic Neoplasms; Postoperative Complications; Risk Factors
PubMed: 36575100
DOI: 10.1016/j.asjsur.2022.12.044 -
Cirugia Y Cirujanos 2022To compare the short-term outcomes of patients undergoing open DP (ODP) and laparoscopic DP (LDP); and to analyze the association between the section site of the...
AIMS
To compare the short-term outcomes of patients undergoing open DP (ODP) and laparoscopic DP (LDP); and to analyze the association between the section site of the pancreas and pancreatic fistula.
MATERIALS AND METHODS
Clinical, perioperative, and histopathologic data of patients who underwent ODP and LDP between 2009 and 2019 were retrospectively analyzed.
RESULTS
70 patients were included. 39 (56%) underwent ODP and 31 (44%) underwent LDP. The tumor size in ODP group was 70mm and in LDP group was 45mm (p = 0,032) Blood loss was lower in LDP group (229mL versus 498mL) (p = 0,001). Operative time, spleen preservation, B/C pancreatic fistula, major morbidity, reoperation, and length of hospital stay, were similar in both groups. There was no postoperative mortality. No differences were found in B/C pancreatic fistula rate regarding to pancreatic transection site.
CONCLUSIONS
LDP is a safe procedure, with perioperative outcomes similar to ODP and with less blood loss. The pancreatic transection site did not influence post-operative pancreatic fistula rate.
Topics: Hospitals; Humans; Pancreatectomy; Pancreatic Fistula; Pancreatic Neoplasms; Postoperative Complications; Retrospective Studies
PubMed: 35636945
DOI: 10.24875/CIRU.20001247