Pylorus- and spleen-preserving total pancreatoduodenectomy with resection of both whole splenic vessels: feasibility and laparoscopic application to intraductal papillary mucin-producing tumors of the pancreas

Choi, Sung Hoon; Hwang, Ho Kyoung; Kang, Chang Moo; Yoon, Chung Sik; Lee, Woo Jung

doi:10.1007/s00464-011-2113-3

Cited by 32 publications

(31 citation statements)

References 20 publications

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“…Studies suggest the minimally invasive approach is not only feasible but equivalently efficacious and safe: with similar perioperative morbidity and mortality (6)(7)(8)(9)(10)(15)(16)(17)(18)(19). In particular, the minimally invasive approach to distal pancreatectomy has been widely accepted and clearly demonstrated advantages such as reduced blood loss, reduced overall complication rate, reduced surgical site infection and shorter hospital length of stay (7)(8)(9)(10)17).…”

Section: Discussionmentioning

confidence: 99%

“…In particular, the minimally invasive approach to distal pancreatectomy has been widely accepted and clearly demonstrated advantages such as reduced blood loss, reduced overall complication rate, reduced surgical site infection and shorter hospital length of stay (7)(8)(9)(10)17). Laparoscopic TP remains a rare procedure, but has shown recent increased use in high volume centers and similarly shown to be safe and feasible (15,16,18,19). A comprehensive review of our initial experience revealed those receiving LTPIAT had significantly shorter hospitalization with median length of stay being 10.5 compared to 14 days for open surgery as well as significant decrease in median postoperative dose of opiate on discharge in the laparoscopic group compared to open (16).…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic total pancreatectomy with islet autotransplantation for chronic pancreatitis

et al. 2016

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Background: Pain from chronic pancreatitis can be debilitating and have far-reaching personal and societal consequences. These consequences can include patient debilitation, worsening of comorbid conditions, narcotic dependence, and implications for health care policy. A variety of surgical procedures have shown limited efficacy for relieving pain in this cohort of patients, and a highly select subset may benefit from a total pancreatectomy (TP). While a brittle form of diabetes can result from TP alone, when combined with islet cell autotransplantation this procedural complication can be minimized. Further, utilizing a minimally invasive approach may be associated with decreased periprocedural pain and length of hospital stay.Methods: We describe our experience at a single high-volume center in the United States. We present our preferred preoperative evaluation, our updated operative techniques, and the standard perioperative care required following this complex laparoscopic procedure.Results: Between 2013 and 2015, there were 20 patients who underwent laparoscopic total pancreatectomy with islet autotransplantation (LTPIAT). Perioperative mortality was 0%.Conclusions: At a high volume pancreatic center with experienced laparoscopic pancreatic surgeons, LTPIAT is feasible and safe for the management of chronic pancreatitis refractory to prior medical and surgical therapies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laparoscopic total pancreatectomy with islet autotransplantation for chronic pancreatitis

et al. 2016

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“…[14][15][16][17] In selected patients, a short operative time (270 and 360 minutes) and minimal blood loss (200 and 300 mL) can be obtained and are comparable and even lower than with an open approach. 10,18 Although many lagers reports on laparoscopic PD had been published, 19,20 this technique is still not used extensively because of the complexity of both dissection but especially the reconstruction phase.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 Although laparoscopic distal pancreatic resection and less frequently pancreaticoduodenectomy (PD) are increasingly performed, only a few cases of laparoscopic TP (LTP) have been reported. [14][15][16][17] The laparoscopic approach may have many advantages for this indication compared with an open approach or other types of laparoscopic pancreatic resections.…”

Section: Introductionmentioning

confidence: 99%

Hand-Assisted Laparoscopic Total Pancreatectomy: A Report of Two Cases

Dokmak

Aussilhou

Sauvanet

et al. 2013

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…Only minimal to moderate perigastric fundal varices were noted without gastrointestinal bleeding. Thus, PpSpTPD with segmental resection of both splenic vessels can be indicated in selected patients [30]. The procedure has also been performed laparoscopically [31].…”

Section: Modified Surgical Techniquesmentioning

confidence: 99%

Are There Indications for Total Pancreatectomy in 2016?

2016

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An elective total pancreatectomy (TP) was first performed by Eugene Rockey of Portland, Oregon, in 1942. In the 1960s and 1970s, TP was the routine resection for pancreatic cancer in many centers because of fear of a leaking pancreatojejunostomy and multicentricity of the disease but the result used to be dreadful (in today's perspective). However, more recently, postoperative mortality and morbidity after pancreatic resections have improved due to better anastomotic technique and pre-, peri- and postoperative care. Today, TP - despite being a more extensive operation - can be offered with about the same operation risk as that of a Whipple procedure. Also, major improvements in the control of diabetes have been seen and there is actually an ongoing discussion on the actual severity of the diabetic state after TP. Also, the development of modern pancreatic enzyme preparations with sufficient control of endocrine and exocrine pancreatic insufficiency provides options for overcoming the postoperative problems following TP. Due to the improved results, there are today different - and more specific - indications than before for TP: malignant tumors growing from the pancreatic head into the left pancreas, pancreatic head cancer where it is not possible to secure a tumor-free resection margin with extended resection or with dubious changes in the pancreatic main duct at frozen section, recurrent malignancy in the pancreatic remnant, at cancer surgery with resection of the celiac trunk, rescue pancreatectomy after a leaking pancreatojejunostomy with sepsis or bleeding after a Whipple-type first resection, multifocal intraductal papillary mucinous neoplasm with potentially malignant foci present in all parts of the gland, multiple metastases of renal cell carcinoma and melanoma without any residual tumor outside the pancreatic gland (possibly also other specified but uncommon metastatic tumors with a potential for cure by pancreatectomy), multifocal neuroendocrine tumors including multiple endocrine neoplasia and hereditary pancreatic cancer with a high grade of cancer penetration risk for the bearers.

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Pylorus- and spleen-preserving total pancreatoduodenectomy with resection of both whole splenic vessels: feasibility and laparoscopic application to intraductal papillary mucin-producing tumors of the pancreas

Abstract: PpSpTPD with segmental resection of both splenic vessels is feasible and safe. Even a minimally invasive approach can be indicated in selected patients.

Cited by 32 publications

References 20 publications

Laparoscopic total pancreatectomy with islet autotransplantation for chronic pancreatitis

Laparoscopic total pancreatectomy with islet autotransplantation for chronic pancreatitis

Hand-Assisted Laparoscopic Total Pancreatectomy: A Report of Two Cases

Are There Indications for Total Pancreatectomy in 2016?

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