Laparoscopic central pancreatectomy for benign or low-grade malignant lesions in the pancreatic neck and proximal body

Song, Ki Byung; Kim, Song Cheol; Park, Kwang-Min; Hwang, Dae Wook; Lee, Jae Hoon; Lee, Dong Joo; Lee, Jung Woo; Jun, Eun Sung; Shin, Sang Hyun; Kim, Hyoung Eun; Lee, Young‐Joo

doi:10.1007/s00464-014-3756-7

Cited by 65 publications

(60 citation statements)

References 34 publications

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“…Sample sizes in individual studies ranged from 20 to 4775 patients, with a total of 9970 patients included for analysis. Table summarizes the study characteristics and key results for the included studies . These studies included 5636 patients undergoing pancreaticoduodenectomy, 3922 patients with distal pancreatectomy and 315 undergoing central pancreatectomy.…”

Section: Resultsmentioning

confidence: 99%

“…Incidence 9%‐24% (pooled estimate 16%; 95% CI: 14%‐17%), Q = 18.20; P = .31, I 2 = 12.10%. B, Distal pancreatectomy performed for resection of neoplasm . Random effects model.…”

Section: Resultsmentioning

confidence: 99%

“…Incidence 3%‐40% (pooled estimate 21%; 95% CI: 16%‐25%), Q = 124.97; P = <.01, I 2 = 85.60%. C, Central pancreatectomy . Random effects model.…”

Section: Resultsmentioning

confidence: 99%

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Risk factors for development of diabetes mellitus (Type 3c) after partial pancreatectomy: A systematic review

Nahm

Jamieson

et al. 2020

Clinical Endocrinology

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Objectives: Type 3c diabetes mellitus (T3cDM) occurring post pancreatectomy can be challenging to treat due to the frequent combination of decreased circulating levels of insulin and glucagon and concurrent exocrine insufficiency. Relatively, little is known regarding the risk factors for development of T3cDM post pancreatectomy. Our aim was to review the literature and assess what is known of the risk factors for the development of new-onset DM following partial pancreatic resection and where possible determines the incidence, time of onset and the management approach to hyperglycaemia in this context. Design: Medline and Embase databases were reviewed using specific keyword criteria. Original manuscripts published in 1990 or later included. Articles with study population <20, lacking information on new-onset DM, follow-up duration or specifically targeting rare procedures/pathology were excluded. The Newcastle Ottawa Quality Assessment form was applied. Results reported according to PRISMA guidelines. Pooled effect size calculated using random effects model. Patients: Thirty six articles were identified that described a total of 5636 patients undergoing pancreaticoduodenectomy, 3922 patients having distal pancreatectomy and 315 with central pancreatectomy.Results: The incidence of new-onset DM was significantly different between different types of resection from 9% to 24% after pancreaticoduodenectomy (pooled estimate 16%; 95% CI: 14%-17%), 3%-40% after distal pancreatectomy (pooled estimate 21%; 95% CI: 16%-25%) and 0%-14% after central pancreatectomy (pooled estimate 6%; 95% CI: 3%-9%). Surgical site, higher preoperative HbA1c, fasting plasma glucose and lower remnant pancreatic volume had strongest associations with new-onset DM.Conclusions: This systematic review supports that risk of development of T3cDM is associated with type of pancreatic resection, lower remnant pancreatic volume and higher preoperative HbA1c. K E Y W O R D Sdiabetes mellitus, pancreatectomy, pancreatic insufficiency, pancreaticoduodenectomy, Whipple's procedure | 397 WU et al.

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Section: Resultsmentioning

confidence: 99%

“…Incidence 9%‐24% (pooled estimate 16%; 95% CI: 14%‐17%), Q = 18.20; P = .31, I 2 = 12.10%. B, Distal pancreatectomy performed for resection of neoplasm . Random effects model.…”

Section: Resultsmentioning

confidence: 99%

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Risk factors for development of diabetes mellitus (Type 3c) after partial pancreatectomy: A systematic review

Nahm

Jamieson

et al. 2020

Clinical Endocrinology

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“…For example, there are only 4 papers published in the literature based on 5 patients or more. (12)(13)(14)(15) The largest series so far was published in 2014 by Byung Song et al and it was a comparative study. (14) The authors analyzed the results of pancreatectomies performed for lesions located in the neck and proximal (15) In the authors opinion the most critical and difficult part of the procedure in the laparoscopic approach is pancreaticoenteric reconstruction, requiring one third of the total operative time.…”

Section: Discussion Discussionmentioning

confidence: 99%

Central pancreatectomy - a suitable candidate for robotic surgery

Stanciulea¹,

Dima²,

Eftimie³

et al. 2015

JTMR

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Background: In the last few decades central pancreatectomy is increasedly adopted in treatment of benign pancreatic lesions situated in the body of the pancreas, especially in young patients. With recent advances in technology, patients with these lesions could benefit from the advantages of the robotic approach. Case presentation: We present the case of a 30-years old woman investigated for epigastric pain. CT showed a 3 cm cystic tumor located in the proximal part of the pancreas body. Robotic central pancreatectomy with pancreatogastrostomy was performed. Results: Operative time was 220 minutes with minimal blood loss. The postoperative course was marked by a basal left pneumonia on postoperative day 3 treated conservatively. The patient was discharged home on postoperative day 8. Pathology showed a 30 mm well differentiated neuroendocrine tumor with free resection margins. Conclusions: Robotic systems offer several advantages compared to laparoscopy: increased and stabile tridimensional view of the operative field and articulated instruments. Robotic central pancreatectomy seems to be a suitable candidate for robotic surgery requiring delicate vascular dissection and a safe reconstruction. Although there are only few cases published in the literature so far, robotics could lead to an increased adoption of minimally invasive techniques in difficult pancreatic procedures, especially in those requiring reconstructions.

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“…(2) A pancreaticogastrostomy appears to be the first choice when a minimally-invasive CP is performed. (70)(71)(72)75,76) Currently, there is no consensus regarding the best approach to the distal pancreatic remnant after a CP or a pancreaticoduodenectomy. Thus, Venara and coworkers have shown, in a single center experience, that the postoperative pancreatic fistula rate was higher when a pancreaticogastrostomy was performed.…”

Section: Indications and Contraindications For A Central Pancreatectomentioning

confidence: 99%

Central pancreatectomy revisited

Dumitraşcu¹,

Popescu²

2015

JTMR

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Central pancreatectomy (CP) is a parenchyma-sparing alternative resection to distal pancreatectomy, for benign and low malignant potential tumors located on the pancreatic isthmus and/ or body. Pancreatic metastases of other neoplasia might also benefit after a CP, in selected patients. Dagradi and Serio described the modern technique of CP, while Iacono introduced it in current clinical practice. An open CP represents the standard, but there is an emerging role for the minimally-invasive approach, which might become a standard for CP in experienced centers, particularly for the robotic approach. The rationale of a CP was to preserve the postoperative pancreatic functions because it implies the loss of a minimal amount of normal pancreatic tissue. However, the real clinical benefit of a CP is still controversial. High overall morbidity and pancreatic fistula rates were reported after a CP. However, most of the complications after a CP have been conservatively managed, with almost zero mortality. A CP has a minimal impact on the postoperative pancreatic functions; the diabetes mellitus rate after a CP is significantly lower, compared with the distal pancreatectomies. A proper selection of candidates for a CP is recommended. Thus, tumors located on the pancreatic isthmus are more likely to benefit after a CP, because the alternative surgical technique in these patients is an extended left pancreatectomy, a procedure with increased risk of postoperative pancreatic insufficiencies. Individual patient-related factors should be taken into consideration in the selection of the patients. Thus, a CP should be used in young patients, non-obese and without diabetes mellitus, with a good biological status, which might be able to overcome the potential postoperative complications. A CP can be safely incorporated into an experienced pancreatic surgeon armamentarium, albeit it represents an uncommon pancreatic resection. Abbreviations: Central pancreatectomy (CP); Physiologic and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM).

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Laparoscopic central pancreatectomy for benign or low-grade malignant lesions in the pancreatic neck and proximal body

Cited by 65 publications

References 34 publications

Risk factors for development of diabetes mellitus (Type 3c) after partial pancreatectomy: A systematic review

Risk factors for development of diabetes mellitus (Type 3c) after partial pancreatectomy: A systematic review

Central pancreatectomy - a suitable candidate for robotic surgery

Central pancreatectomy revisited

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