Central pancreatectomy prevents postoperative diabetes

Klotz, Rosa; Schilling, Constanze; Kuner, Charlotte; Hinz, Ulf; Klaiber, Ulla; Holze, Magdalena; Tjaden, Christine; Loos, Martin; Büchler, Markus W.; Hackert, Thilo

doi:10.1002/jhbp.1296

Cited by 7 publications

(9 citation statements)

References 31 publications

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“…The main purpose of CP is to preserve pancreatic endocrine function by preserving the pancreatic tail and to maintain patient quality of life. Our literature search for articles on the comparison between CP and DP identified several studies published since 2010 [14][15][16][17][18][19][20][21][22][23][24][25][26][27] that had compared postoperative endocrine function between CP and DP cases (Table 1). As shown in Table 1, most of the studies presented the results of single-center retrospective studies or meta-analyses aggregating those retrospective studies.…”

Section: Clinical Significance Of Pancreatic Tail Preservation In Cpmentioning

confidence: 99%

Recent trends in organ‐preserving pancreatectomy: Its problems and clinical advantages compared with other standard pancreatectomies

Kato,

Asano,

Ito

et al. 2023

Annals of Gastroent Surgery

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In this review article, we focus on recent papers on organ‐preserving pancreatectomy procedures published since 2010. When comparing central pancreatectomy (CP) and distal pancreatectomy (DP), most studies have concluded that the CP group exhibited significantly lower incidence of new‐onset diabetes or diabetes exacerbation than the DP group postoperatively. However, because of increased incidence of morbidities such as pancreatic fistula, the surgeon faces a considerable trade‐off between increased short‐term morbidity and long‐term preservation of endocrine function. When the outcomes of two types of spleen‐preserving DP (Kimura and Warshaw procedures) are compared, most studies mentioned the low incidence of postoperative gastric varices and splenic infarction with the Kimura procedure. Although there are several reports regarding the effect of spleen preservation on prevention of postoperative infections, no report on the contribution of spleen preservation to the prevention of overwhelming post‐splenectomy infection is seen. The advantages of duodenum‐preserving pancreatic head resection (DPPHR) concerning endocrine and exocrine functions continue to be subjects of discussion, mainly due to the limited number of institutions that have adopted this approach; however, DPPHR should be presented as an option for patients due to its low incidence of postoperative cholangitis. Organ‐preserving pancreatectomy requires meticulous surgical techniques, and postoperative complications may increase with this surgery compared with standard pancreatectomy, which may be influenced by the surgeon's skill and the surgical facility where the procedure is performed. Nonetheless, this technique has significant long‐term advantages in terms of endocrine and exocrine functions and its wider adoption in the future is expected.

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Section: Clinical Significance Of Pancreatic Tail Preservation In Cpmentioning

confidence: 99%

Recent trends in organ‐preserving pancreatectomy: Its problems and clinical advantages compared with other standard pancreatectomies

Kato,

Asano,

Ito

et al. 2023

Annals of Gastroent Surgery

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“…Central pancreatectomy (CP) is a rarely performed [ 1 , 2 ] and controversial type of pancreatic resection [ 3 ] that is sometimes used as an alternative to distal pancreatectomy mainly for certain benign and low-grade malignant tumors of the pancreatic body and isthmus [ 4 ]. The principal advantage of a CP over a distal pancreatectomy is a better preservation of postoperative pancreatic functions, particularly the endocrine one [ 5 , 6 , 7 , 8 ]. However, a CP is associated with high morbidity rates (higher than distal pancreatectomies) [ 5 , 6 , 7 , 9 ] and exceptionally high rates of postoperative pancreatic fistulae (POPF) [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The jejunum is primarily used for distal pancreatic stump anastomoses after CP [ 1 , 4 , 8 , 11 , 12 , 16 ]. However, in a few centers, an anastomosis with the stomach is preferred for the distal pancreatic stump after CP [ 10 , 17 , 18 ], especially in a minimally invasive approach [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Duct-to-Mucosa vs. Invagination Pancreatojejunostomy: Toward a Personalized Approach for Distal Pancreatic Stump Anastomosis in Central Pancreatectomy?

Dumitraşcu

Popescu

2023

JPM

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(1) Background: The jejunum is primarily used for distal pancreatic stump anastomoses after central pancreatectomy (CP). The study aimed to compare duct-to-mucosa (WJ) and distal pancreatic invagination into jejunum anastomoses (PJ) after CP. (2) Methods: All patients with CP and jejunal anastomoses (between 1 January 2002 and 31 December 2022) were retrospectively assessed and compared. (3) Results: 29 CP were analyzed: WJ—12 patients (41.4%) and PJ—17 patients (58.6%). The operative time was significantly higher in the WJ vs. PJ group of patients (195 min vs. 140 min, p = 0.012). Statistically higher rates of patients within the high-risk fistula group were observed in the PJ vs. WJ group (52.9% vs. 0%, p = 0.003). However, no differences were observed between the groups regarding the overall, severe, and specific postpancreatectomy morbidity rates (p values ≥ 0.170). (4) Conclusions: The WJ and PJ anastomoses after CP were comparable in terms of morbidity rates. However, a PJ anastomosis appeared to fit better for patients with high-risk fistula scores. Thus, a personalized, patient-adapted technique for the distal pancreatic stump anastomosis with the jejunum after CP should be considered. At the same time, future research should explore gastric anastomoses’ emerging role.

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mentioning

confidence: 99%

“…CP generally can be performed as an alternative surgical approach to DP in the treatment of benign or low-grade malignant lesions located in the pancreatic neck and body in order to reduce the loss of parenchyma and therefore postoperative endocrine and exocrine pancreatic failure [9,10]. Thus, CP offers improved endocrine and exocrine longterm results at the expense of a higher risk of postpancreatectomy hemorrhage (PPH) and POPF without increased perioperative mortality [10]. Indications for CP are the following: benign or borderline lesions located in the pancreatic neck or proximal body, inability of enucleation of the lesion located within the pancreatic isthmus/proximal body, and trauma-related injury to the isthmus/proximal body [1,11,12].…”

mentioning

confidence: 99%

Pancreatectomy and Pancreatic Surgery

Jabłońska

Mrowiec

2023

Life

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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) [...]

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Central pancreatectomy prevents postoperative diabetes

Cited by 7 publications

References 31 publications

Recent trends in organ‐preserving pancreatectomy: Its problems and clinical advantages compared with other standard pancreatectomies

Recent trends in organ‐preserving pancreatectomy: Its problems and clinical advantages compared with other standard pancreatectomies

Outcomes of Duct-to-Mucosa vs. Invagination Pancreatojejunostomy: Toward a Personalized Approach for Distal Pancreatic Stump Anastomosis in Central Pancreatectomy?

Pancreatectomy and Pancreatic Surgery

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