Middle-preserving pancreatectomy for synchronous ampullary carcinoma and solid-pseudopapillary tumor of distal pancreas

Chen, Huanwei; Wang, Fengjie; Lai, Eric C. H.; Lau, Wan Yee

doi:10.1016/j.ijscr.2011.08.007

Cited by 8 publications

(2 citation statements)

References 6 publications

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“…From data shown in Table 1, it is apparent that MPP is mainly acceptable for muticentric periampullary-pancreatic benign, borderline, low-grade malignant lesions and pancreatic metastases from other tumors in which lymphadenectomy is not necessary. However, six patients were diagnosed with primary periampullary-pancreatic invasive cancer [1,4,11,12]. One major concern that might be raised is whether MPP guarantees tumor-free margins and sufficiently extensive lymph node dissection in these situations.…”

Section: Discussionmentioning

confidence: 99%

“…One major concern that might be raised is whether MPP guarantees tumor-free margins and sufficiently extensive lymph node dissection in these situations. According to the surgical principles of treating pancreatic cancer [16], as long as the multicentric invasive cancers do not affect both the proximal and the distal portions of the pancreas, synchronously or metachronously, MPP should be pursued whenever possible since in theory, it would offer sufficient extent of resection and nodal clearance, as demonstrated in previous reports [1,11,12]. Although a two-stage MPP was applied in one patient who presented with multicentric metachronous pancreatic adenocarcinoma [4], we would not advocate MPP in such situations because it evidently betrays the oncological surgical resection principle [16].…”

Section: Discussionmentioning

confidence: 99%

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Middle-preserving pancreatectomy: report of two cases and review of the literature

et al. 2013

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BackgroundMiddle-preserving pancreatectomy (MPP) is a parenchyma-sparing surgical procedure which has recently been sporadically reported for the treatment of multicentric periampullary-pancreatic lesions. However, a comprehensive recognition of this procedure has not been clearly elucidated.Case presentationWe herein report two patients undergoing MPP due to synchronous multicentric pancreatic neoplasm. Patient one was a 24-year-old woman with a multicentric solid pseudopapillary neoplasm (SPN) and patient two was a 36-year-old woman with a multicentric serous cystic neoplasm (SCN). Simultaneous atypical pancreaticoduodenectomy and atypical left pancreatectomy were performed in patient one; simultaneous standard pancreaticoduodenectomy and atypical left pancreatectomy with spleen preservation were performed in patient two. Approximately 6 cm and 5 cm segments of the middle portion of the pancreas were preserved, respectively. At follow-up at 36 months and 6 months respectively, patient one had developed diabetes and malabsorption requiring dietary control, exercise and pancreatic enzyme supplement whereas patient two showed normal fasting blood glucose without diarrhea. Both patients were disease-free and in good nutritional condition. We reviewed twenty cases of MPP that were previously reported in the literature. Patient characteristics, surgical techniques and short- and long-term outcomes were analyzed.ConclusionMPP is mainly beneficial for multicentric noninvasive periampullary-pancreatic lesions. However, for multicentric periampullary-pancreatic lesions involving even primary invasive cancers, as long as the invasive cancers affect only one side of the pancreas (proximal or distal), MPP could serve as a rational choice in well-selected patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Middle-preserving pancreatectomy: report of two cases and review of the literature

et al. 2013

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Middle-segment preserving pancreatectomy: a literature review and case report

Mihara,

Takemura,

Yoshizaki

et al. 2024

Langenbecks Arch Surg

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Middle-preserving pancreatectomy with reversed pancreaticogastrostomy: report of a case

et al. 2013

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Parenchyma-sparing pancreatic resections have been reported increasingly in recent years; however, for multifocal diseases involving the head and the tail of the pancreas, total pancreatectomy is still the preferred procedure. The possible consequence of this procedure is loss of normal pancreatic parenchyma, resulting in insufficiency of pancreatic exocrine and endocrine functions. Various types of limited resection have been introduced for isolated or multiple pancreatic lesions, depending on the location of the tumor. Even for multifocal diseases, if the pancreatic body is spared, a middle-preserving pancreatectomy (MPP) can be performed to assure maximal pancreatic function and uncompromised quality of life. Yet, few papers have introduced the feasibility of MPP for a better outcome. This report describes a new surgical technique for MPP using an alternative approach for the remnant pancreas anastomosis. We used this technique successfully to remove a bifocal neoplasm: adenocarcinoma of the distal bile duct and mucinous cyst adenoma in the tail of the pancreas.

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Middle-preserving pancreatectomy for synchronous ampullary carcinoma and solid-pseudopapillary tumor of distal pancreas

Abstract: Middle-preserving pancreatectomy is a safe and feasible option for patient with multicentric or synchronous pancreatic pathologies.

Cited by 8 publications

References 6 publications

Middle-preserving pancreatectomy: report of two cases and review of the literature

Middle-preserving pancreatectomy: report of two cases and review of the literature

Middle-segment preserving pancreatectomy: a literature review and case report

Middle-preserving pancreatectomy with reversed pancreaticogastrostomy: report of a case

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