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Khirurgiia 2023To justify organ-preserving variants of total pancreatectomy.
OBJECTIVE
To justify organ-preserving variants of total pancreatectomy.
MATERIAL AND METHODS
We retrospectively analyzed the results of classic and modified total pancreatectomy between September 2010 and March 2021. Implementing pylorus-sparing total pancreatectomy with preservation of stomach, spleen, gastric and splenic vessels, we thoroughly analyzed exocrine/endocrine disorders after total pancreatectomy and changes in immune status after splenectomy. Serum C-reactive protein and ferritin were assessed in 1, 3, 5, 7, 14 and 30 days after surgery in both groups. We also estimated daily glycemic profile after total pancreatectomy in classical and organ-preserving modifications.
RESULTS
We performed 37 total pancreatectomies including 12 pylorus-preserving total pancreatectomies with preservation of stomach, spleen, gastric and splenic vessels. General and specific postoperative complication rate was significantly lower after modified surgery compared to classic total pancreatectomy with gastric resection and splenectomy.
CONCLUSION
Modified total pancreatectomy is preferable for low-grade pancreatic tumors.
Topics: Humans; Laparoscopy; Pancreatectomy; Pancreatic Neoplasms; Retrospective Studies; Spleen; Splenectomy; Treatment Outcome; Organ Sparing Treatments
PubMed: 36748865
DOI: 10.17116/hirurgia20230215 -
The British Journal of Surgery Sep 1952
Topics: Pancreas; Pancreatectomy
PubMed: 12987638
DOI: 10.1002/bjs.18004016003 -
Digestive Surgery 2016Intraductal papillary mucinous neoplasms (IPMN) are cystic precursors to pancreatic cancer believed to arise within a widespread neoplastic field defect. The tendency... (Review)
Review
Intraductal papillary mucinous neoplasms (IPMN) are cystic precursors to pancreatic cancer believed to arise within a widespread neoplastic field defect. The tendency for some patients to present with multifocal disease and/or develop additional lesions over time argues in favor of a field defect and complicates surgical management decisions. Surgery usually consists of partial pancreatic resection, which leaves behind a pancreatic remnant at risk for recurrent disease and progression to cancer. As an alternative, total pancreatectomy (TP) provides the most complete oncologic resection, but postoperative morbidity and quality of life (QoL) issues have generally limited its use to only the highest risk patients. Significant progress has been made in the management of the post-TP apancreatic state and studies now show less morbidity with acceptable QoL comparable to type 1 diabetic and post-pancreaticoduodenectomy patients. These improvements do not yet justify the routine use of TP, but they have opened the door for expansion to additional subsets of non-invasive IPMN. Here, we have identified several groups of patients that we believe would benefit from TP over partial resection based on the most current literature.
Topics: Humans; Margins of Excision; Neoplasm Recurrence, Local; Neoplasm, Residual; Neoplasms, Cystic, Mucinous, and Serous; Neoplasms, Multiple Primary; Pancreatectomy; Pancreatic Ducts; Pancreatic Neoplasms; Patient Selection; Practice Guidelines as Topic; Quality of Life
PubMed: 27215900
DOI: 10.1159/000445019 -
HPB : the Official Journal of the... Jul 2023Minimally invasive total pancreatectomy (MITP) is considered safe and feasible with limited evidence on this procedure. The aim of this study was to systematically... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Minimally invasive total pancreatectomy (MITP) is considered safe and feasible with limited evidence on this procedure. The aim of this study was to systematically analyze the current literature on MITP compared to open TP (OTP).
METHOD
Randomized controlled trials and prospective non-randomized comparative studies were sought systematically in MEDLINE, Web of Science and CENTRAL from their inception until December 2021. Outcome measures included operative time, length of hospital stay (LOH), spleen-preservation rate, estimated blood loss (EBL), need for transfusion, venous resection rate, delayed gastric emptying (DGE), biliary leakage, postpancreatectomy hemorrhage (PPH), reoperation rate, overall 30-day morbidity (Clavien-Dindo > IIIa), 90-day mortality, 90-day readmission, examined lymph nodes (ELN). Pooled results are presented as odds ratios (OR) or mean difference (MD) with 95% confidence interval (CI).
RESULTS
7 observational studies with a total of 4212 patients were included. MITP had a decreased EBL and transfusion rate, lower 30-day morbidity and 90-day mortality with a longer LOH compared to OTP. There were no significant differences regarding operative time, spleen preservation rate, DGE, biliary leakage, venous resection rate, PPH, reoperation, 90-day readmission and ELN.
DISCUSSION
Based on the available studies, MITP is safe and feasible compared to OTP in highly experienced hands from high-volume centers. Further high-quality studies are needed to verify the conclusion.
Topics: Humans; Pancreatectomy; Pancreaticoduodenectomy; Postoperative Complications; Prospective Studies; Minimally Invasive Surgical Procedures; Laparoscopy
PubMed: 37032259
DOI: 10.1016/j.hpb.2023.01.012 -
Surgery Today Jul 2013Achieving pain relief and improving the quality of life are the main targets of treatment for patients with chronic pancreatitis. The use of total pancreatectomy to... (Review)
Review
Achieving pain relief and improving the quality of life are the main targets of treatment for patients with chronic pancreatitis. The use of total pancreatectomy to treat chronic pancreatitis is a radical and in some ways ideal strategy. However, total pancreatectomy is associated with severe diabetic control problems. Total pancreatectomy with islet autotransplantation can relieve severe pain and prevent the development of postsurgical diabetes. With islet autotransplantation, patients with chronic pancreatitis receive their own islet cells and therefore do not require immunosuppressive therapy. In the future, total pancreatectomy with islet autotransplantation may be considered a treatment option for chronic pancreatitis patients.
Topics: Diabetes Mellitus; Humans; Islets of Langerhans Transplantation; Pancreatectomy; Pancreatitis, Chronic; Postoperative Complications; Transplantation, Autologous
PubMed: 23073847
DOI: 10.1007/s00595-012-0382-7 -
Khirurgiia 2023Pancreatic surgery expands the indications and the use of total pancreatectomy. Considering a rather high rate of postoperative complications, the search for the ways to...
INTRODUCTION
Pancreatic surgery expands the indications and the use of total pancreatectomy. Considering a rather high rate of postoperative complications, the search for the ways to improve its outcomes is extremely relevant. The purpose of this study is justification and implementation of organ-preserving variants of total pancreatectomy.
MATERIAL AND METHODS
Retrospective analysis of treatment results after classic and modified total pancreatectomy in the surgical clinic of Botkin Hospital was performed from September 2010 to March 2021. During the development and implementation of pylorus-preserving total pancreatectomy with preservation of the stomach, spleen, gastric and splenic vessels, we thoroughly analyzed aspects of exocrine/endocrine disorders and changes of the immune status after performing the modified technique.
RESULTS
We performed 37 total pancreatectomies, including 12 pylorus-preserving total pancreatectomies with preservation of the stomach, spleen, gastric, and splenic vessels. General and specific postoperative complication rate in patients after the modified operation was significantly lower compared to the results of classic total pancreatectomy with gastric resection and splenectomy.
CONCLUSION
Modified total pancreatectomy is a method of choice for pancreatic tumors of low malignant potential.
Topics: Humans; Spleen; Pancreatectomy; Retrospective Studies; Splenectomy; Stomach; Pancreatic Neoplasms; Treatment Outcome; Postoperative Complications; Laparoscopy
PubMed: 37186645
DOI: 10.17116/hirurgia20230515 -
Surgical Laparoscopy, Endoscopy &... Apr 2018Although minimally invasive pancreatectomy has been performed increasingly for pancreatic malignancies, many authors feel that a history of pancreatitis is a...
Although minimally invasive pancreatectomy has been performed increasingly for pancreatic malignancies, many authors feel that a history of pancreatitis is a contraindication to either laparoscopic or robotic-assisted pancreatectomy. Shown here is a video (Supplemental Digital Content 1, http://links.lww.com/SLE/A172) of a laparoscopic total pancreatectomy with splenectomy for chronic pancreatitis. This patient was denied auto-islet cell transplantation because of insurance restraints. In total, 4 laparoscopic total pancreatectomies have been attempted and completed. Indications for laparoscopic total pancreatectomy have been 2 for diffuse intraductal papillary mucinous neoplasm, 1 for pancreatic adenocarcinoma, and the above-mentioned patient. No patient suffered a biliary leak, and the average length of stay was 5 days (range, 4 to 8 d). History of pancreatitis is a relative contraindication to minimally invasive pancreatectomy. It should be performed by surgeons with expertise in both open and minimally invasive pancreatic surgery.
Topics: Follow-Up Studies; Humans; Laparoscopy; Pancreas; Pancreatectomy; Pancreatitis, Chronic
PubMed: 29528950
DOI: 10.1097/SLE.0000000000000519 -
Islets Dec 2023Patients with chronic pancreatitis (CP) often have severe and intractable abdominal pain, leading to decreased quality of life (QOL), inability to work or attend school,...
BACKGROUND
Patients with chronic pancreatitis (CP) often have severe and intractable abdominal pain, leading to decreased quality of life (QOL), inability to work or attend school, and increased health care costs due to repeated emergency room visits and hospitalizations.
METHODS
We evaluated the efficacy of total pancreatectomy and islet autotransplantation (TPIAT) in terms of pain control and QOL in CP patients treated at our center in Japan. To evaluate QOL, we used the Short-Form 36 Health Survey version 2 (SF-36v2 Standard, Japanese), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), and Quality of Life Questionnaire-Pancreatic Modification (QLQ-PAN28).
RESULTS
Between August 2016 and June 2019, we performed this procedure in 5 patients. All patients were followed up for 12 months and all transplanted islets were still functioning at the 1-year follow-up. The major adverse events were abdominal wall hemorrhage, intestinal obstruction, intra-abdominal abscess, and abdominal pain requiring hospitalization; no case had sequelae. No major complications were due to islet transplantation. Pain scores improved postoperatively in all patients. Three QOL item dimensions role-physical ( = 0.03125), general health perception ( = 0.03125) and vitality ( = 0.03125) in the SF-36 were significantly improved 12 months after TPIAT. Mean values of many other QOL items improved, though not significantly.
CONCLUSION
The QOL improvement after TPIAT for CP suggests its effectiveness in the Japanese population.
Topics: Humans; Pancreatectomy; Transplantation, Autologous; Quality of Life; Japan; Treatment Outcome; Pancreatitis, Chronic; Islets of Langerhans Transplantation; Abdominal Pain
PubMed: 37087752
DOI: 10.1080/19382014.2023.2202092 -
International Journal of Surgery... Jul 2023The aim of this study was to perform a systematic review and meta-analysis on the safety and effectiveness regarding outcomes of minimally invasive total pancreatectomy... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this study was to perform a systematic review and meta-analysis on the safety and effectiveness regarding outcomes of minimally invasive total pancreatectomy (MITP) versus open total pancreatectomy (OTP).
BACKGROUND
Total pancreatectomy is a complicated operation in abdominal surgery. The flexibility of minimally invasive surgery offers a new surgical approach to this technology. At present, there is little research on MITP, and its advantages over OTP remain uncertain.
METHODS
A systematic literature review and meta-analysis was conducted basing on comparative studies between MITP and OTP from January 1943 to November 2022. Intraoperative outcomes and postoperative outcomes were assessed. Pooled odds ratios (ORs) and mean differences with a 95% CI were calculated using fixed-effect or random-effect models under heterogeneity.
RESULTS
Seven studies with a total of 4275 patients were included. The major morbidity in the MITP group was significant lower (OR 0.50, 95% CI: 0.30-0.84, P=0.008, I²= 0%) than OTP group. At the same time, comparing with OTP, the MITP group had lower estimated blood loss (MD -362.50, 95% CI -641.34 to -83.66, P=0.01, I²=96%) and lower intraoperative transfusion rate (OR 0.36, 95% CI 0.16-0.84, P=0.02, I²=0%). There were no significant differences between the MITP and OTP groups for other outcomes.
CONCLUSIONS
The results suggested that MITP was associated with lower major morbidity, estimated blood loss, and intraoperative transfusion rate comparing with OTP. However, the further evidence with a better design is required.
Topics: Humans; Pancreatectomy; Blood Loss, Surgical; Minimally Invasive Surgical Procedures; Length of Stay; Blood Transfusion; Postoperative Complications
PubMed: 37485920
DOI: 10.1097/JS9.0000000000000392 -
Surgery Today Oct 2021To investigate whether proximal subtotal pancreatectomy (PSTP) is superior to total pancreatectomy (TP) for preserving postoperative endocrine function, and to identify...
PURPOSE
To investigate whether proximal subtotal pancreatectomy (PSTP) is superior to total pancreatectomy (TP) for preserving postoperative endocrine function, and to identify the pre-operative risk factors influencing prognosis after TP and PSTP.
METHODS
The subjects of this retrospective study were patients who underwent TP (n = 15) or PSTP (n = 16) between 2008 and 2018 in our hospital. First, we compared the incidence of hypoglycemia within 30 days after surgery and the total daily amount of insulin needed in the 30 days after TP vs. PSTP. Then, we compared the prognoses between the groups.
RESULTS
The incidence of hypoglycemia in the 30 days after surgery was significantly lower in the PSTP group than in the TP group (n = 0 vs. n = 5; p < 0.001). The total amount of daily insulin given was also significantly lower after PSTP than after TP: (0 units vs. 18 units, p = 0.001). Lower lymphocyte counts (p = 0.014), lower cholinesterase (p = 0.021), and lower prognostic nutrition index (p = 0.021) were identified as significant risk factors for hypoglycemia in the TP group. Low cholinesterase (p = 0.015) and a low prognostic nutrition index (p = 0.048) were significantly associated with an unfavorable prognosis in the TP group, but not in the PSTP group.
CONCLUSIONS
PSTP may be a feasible alternative to TP to preserve endocrine function, especially for malnourished patients.
Topics: Adult; Aged; Aged, 80 and over; Cholinesterases; Female; Humans; Hypoglycemia; Incidence; Lymphocyte Count; Male; Malnutrition; Middle Aged; Nutrition Assessment; Pancreatectomy; Pancreatic Diseases; Postoperative Complications; Retrospective Studies; Risk Factors; Time Factors
PubMed: 33825950
DOI: 10.1007/s00595-021-02269-7