Laparoscopy assisted middle‐segment–preserving pancreatectomy for multiple pancreatic neuroendocrine tumors: Report of a case

Usui, Masanobu; Kuriyama, Naohisa; Uchida, Keiji; Kishiwada, Masashi; Mizuno, Shugo; Sakurai, Hiroyuki; Tabata, Masami; Shiraishi, Taizo; Isaji, Shuji

doi:10.1111/ases.12107

Cited by 6 publications

(2 citation statements)

References 10 publications

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“…Indications for MPP are pancreatic body-sparing multifocal disease, including PDAC, [9,20] IPMNs, [24,32] neuroendocrine tumors (PNETs), [21,31] and metastatic tumors of the pancreas with a low-grade malignant nature. [23,29,30] In our current series, the major indications were metastatic tumors of the pancreas, including renal cell carcinoma (RCC), DFSP, and pheochromocytoma.…”

Section: Discussionmentioning

confidence: 99%

Small amounts of tissue preserve pancreatic function

Yin

Wei

et al. 2016

Medicine

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Middle-segment preserving pancreatectomy (MPP) is a novel procedure for treating multifocal lesions of the pancreas while preserving pancreatic function. However, long-term pancreatic function after this procedure remains unclear.The aims of this current study are to investigate short- and long-term outcomes, especially long-term pancreatic endocrine function, after MPP.From September 2011 to December 2015, 7 patients underwent MPP in our institution, and 5 cases with long-term outcomes were further analyzed in a retrospective manner. Percentage of tissue preservation was calculated using computed tomography volumetry. Serum insulin and C-peptide levels after oral glucose challenge were evaluated in 5 patients. Beta-cell secreting function including modified homeostasis model assessment of beta-cell function (HOMA2-beta), area under the curve (AUC) for C-peptide, and C-peptide index were evaluated and compared with those after pancreaticoduodenectomy (PD) and total pancreatectomy. Exocrine function was assessed based on questionnaires.Our case series included 3 women and 2 men, with median age of 50 (37–81) years. Four patients underwent pylorus-preserving PD together with distal pancreatectomy (DP), including 1 with spleen preserved. The remaining patient underwent Beger procedure and spleen-preserving DP. Median operation time and estimated intraoperative blood loss were 330 (250–615) min and 800 (400–5500) mL, respectively. Histological examination revealed 3 cases of metastatic lesion to the pancreas, 1 case of chronic pancreatitis, and 1 neuroendocrine tumor. Major postoperative complications included 3 cases of delayed gastric emptying and 2 cases of postoperative pancreatic fistula. Imaging studies showed that segments representing 18.2% to 39.5% of the pancreas with good blood supply had been preserved. With a median 35.0 months of follow-ups on pancreatic functions, only 1 patient developed new-onset diabetes mellitus of the 4 preoperatively euglycemic patients. Beta-cell function parameters in this group of patients were quite comparable to those after Whipple procedure, and seemed better than those after total pancreatectomy. No symptoms of hypoglycemia were identified in any patient, although half of the patients reported symptoms of exocrine insufficiency.In conclusion, MPP is a feasible and effective procedure for middle-segment sparing multicentric lesions in the pancreas, and patients exhibit satisfied endocrine function after surgery.

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Section: Discussionmentioning

confidence: 99%

Small amounts of tissue preserve pancreatic function

Yin

Wei

et al. 2016

Medicine

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“…Some authors have recommended MSPP for patients with multicentric noninvasive lesions, such as IPMNs, and pancreatic metastases, because lymphadenectomy was not necessary [ 6 , 8 – 10 ]. Recently, as a minimally invasive surgery, laparoscopy-assisted MSPP was also reported [ 11 ]. Cheng et al [ 6 ] reviewed 22 patients who underwent MSPP and showed that the overall morbidity was 40.9% (9/22), especially pancreatic fistula was 22.7% (5/22) with no mortality.…”

Section: Case Presentationmentioning

confidence: 99%

Middle segment-preserving pancreatectomy for metachronous intraductal papillary mucinous neoplasm after pancreatoduodenectomy: a case report

et al. 2017

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Total pancreatectomy has occasionally been performed to treat patients with multiple lesions (such as intraductal papillary mucinous neoplasm (IPMN)) or patients who have undergone repeated pancreatic resection. However, deficiencies of the exocrine and endocrine functions worsen patients’ quality of life. Recently, there have been several case reports citing middle segment-preserving pancreatectomy (MSPP) as a safe procedure and beneficial with respect to preservation of the exocrine and endocrine functions. We herein report the case of a patient who underwent MSPP for repeat pancreatectomy for IPMN and in whom a favorable outcome was achieved. The patient, a 70-year-old man, was diagnosed with branch duct-type IPMN (BD-IPMN) with worrisome features in the pancreatic head and a single cyst in the pancreatic tail, during a preoperative examination of early gastric cancer. Pancreatoduodenectomy was performed for BD-IPMN in the pancreatic head and gastric cancer. A histopathological examination showed an intraductal papillary mucinous adenoma (IPMA) with mild-moderate atypia. During the follow-up, the size of the cystic lesion in the pancreatic tail and the diameter of the main pancreatic duct were gradually increasing. Therefore, at 2 years and 6 months after surgery, distal pancreatectomy with preservation of the spleen (namely MSPP) was performed. The pancreatic resection margin was histologically negative. The length and volume of the remnant pancreas were approximately 6 cm and 10 ml, respectively. A histopathological examination showed an IPMA. The patient had no diarrhea or weight loss without digestive enzymes and maintained favorable glucose tolerance without oral hypoglycemic agents or insulin. He has showed no evidence of new lesions in the remnant pancreas at 3 years of follow-up after the last surgery.

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