Review of minimally invasive pancreas surgery and opinion on its incorporation into low volume and resource poor centres

Cawich, Shamir O; Kluger, Michael D.; Francis, Wesley; Deshpande, Rahul; Mohammed, Fawwaz; Bonadie, Kimon O; Thomas, Dexter; Pearce, Neil; Schrope, Beth

doi:10.4240/wjgs.v13.i10.1122

Cited by 13 publications

(6 citation statements)

References 72 publications

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“…Our data also revealed a trend of an increased ratio of MI surgery (0 MI procedures in 10 cases before 2010; 4 MI surgeries out of 14 [29%] after 2010), which may be due to the progress of MI surgery skills, MI instruments, and the robotic system, as published by Cawich et al [30]. However, the SPN locations ratio was similar before and after 2010 (head/body/tail; before 3/3/4, after 5/4/5).…”

Section: Discussionsupporting

confidence: 81%

Surgical Outcomes of Pancreatic Solid Pseudopapillary Neoplasm: Experiences of 24 Patients in a Single Institute

Ku,

Cheng,

Chen

et al. 2024

Medicina

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Background and Objectives: The pancreatic solid pseudopapillary neoplasm (SPN), a rare tumor predominantly affecting young women, has seen an increased incidence due to improved imaging and epidemiological knowledge. This study aimed to understand the outcomes of different interventions, possible complications, and associated risk factors. Materials and Methods: This study retrospectively analyzed 24 patients who underwent pancreatic surgery for SPNs between September 1998 and July 2020. Results: Surgical intervention, typically required for symptomatic cases or pathological confirmation, yielded favorable outcomes with a 5-year survival rate of up to 97%. Despite challenges in standardizing preoperative evaluation and follow-up protocols, aggressive complete resection showed promising long-term survival and good oncological outcomes. Notably, no significant differences were found between conventional and minimally invasive (MI) surgery in perioperative outcomes. Histopathological correlations were lacking in prognosis and locations. Among the patients, one developed diffuse liver metastases 41 months postoperatively but responded well to chemotherapy and transcatheter arterial chemoembolization, with disease stability observed at 159 postoperative months. Another patient developed nonalcoholic steatohepatitis after surgery and underwent liver transplantation, succumbing to poor medication adherence 115 months after surgery. Conclusions: These findings underscore the importance of surgical intervention in managing SPNs and suggest the MI approach as a viable option with comparable outcomes to conventional surgery.

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Section: Discussionsupporting

confidence: 81%

Surgical Outcomes of Pancreatic Solid Pseudopapillary Neoplasm: Experiences of 24 Patients in a Single Institute

Ku,

Cheng,

Chen

et al. 2024

Medicina

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“…К концу XX в. хирурги по всему миру начали применять лапаро-и торакоскопическую хирургию у взрослых и детей, но первые сообщения о лапароскопических резекциях поджелудочной железы у взрослых пациентов стали появляться только в 90-х годах [9][10][11][12][13][14][15][16][17], что обусловлено топографическими и структурными особенностями органа: железа находится глубоко в забрюшинном пространстве, плотно прикреплена к двенадцатиперстной кишке, интимно связана с крупными мезентериальными и селезеночными сосудами и прикрывается внутренними органами. Кроме того, ее мягкая железистая консистенция и способность фиброзировать окружающие ткани в условиях патологии делают ее опасным кандидатом для лапароскопии [18]. M.L.…”

Section: Discussionunclassified

Successful laparoscopic resection of a rare focal form of congenital hyperinsulinism: Case report and literature review

Sukhotskaya

Kagantsov

Bairov

et al. 2023

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

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Congenital hyperinsulinism is a severe disease that causes irreversible damage to the cerebral cortex. This article presents a clinical observation of successful surgical treatment for a child with an extremely rare form of hyperinsulinism accompanied by two foci in the opposite ends of the pancreas. The child was in extremely critical condition from birth due to recurrent hypoglycemia and was diagnosed with hyperinsulinism at the age of two weeks. Specific therapy with diazoxide and octreotide was initiated but proven to be ineffective (parenteral glucose administration was still needed, and octreotide only provided partial results). When the child was one month old, positron emission tomography-computed tomography with 18F-DOPA was performed and revealed the focal hyperfixation of the radiopharmaceutical in the tail and head of the pancreas. This finding indicated the presence of two pathological foci or a focus in the tail and the physiological accumulation of the radiopharmaceutical in the head. At the age of one month and 20 days, the child underwent laparoscopic revision of the pancreas to visualize a focus in the tail that was confirmed by express biopsy. The resection of the tail (15%) was performed with confirmation of clear resection margins. During further revision, a focus was detected in the head. Resection was again performed with histological confirmation of complete resection. On the 12th day after the operation, the child was discharged without therapy with clinical recovery. The child is currently being monitored (for over six months), growing and developing according to age. A fasting test was performed, and the recurrence of hyperinsulinism was ruled out. This article presents a detailed description of the clinical and radiological examination results, the patients history, the surgical techniques, and the intervention results. As part of the discussion, a literature review on the behavior of laparoscopic resections of the pancreas in children with congenital hyperinsulinism was carried out.

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“…This suggests that the specialty surgeons were experienced, although none were high-volume surgeons using conventional criteria in Table 1 . Published data documented that only 12.8 PDs were performed annually at the busiest specialized HPB center in the Caribbean[ 42 ]. Nevertheless, we believe that outcomes can be improved using a modified centralization concept, with attention to the following five points.…”

Section: Caribbean Experiencementioning

confidence: 99%

Whipple’s operation with a modified centralization concept: A model in low-volume Caribbean centers

Cawich¹,

Pearce²,

Naraynsingh³

et al. 2022

WJCC

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Conventional data suggest that complex operations, such as a pancreaticoduodenectomy (PD), should be limited to high volume centers. However, this is not practical in small, resource-poor countries in the Caribbean. In these settings, patients have no option but to have their PDs performed locally at low volumes, occasionally by general surgeons. In this paper, we review the evolution of the concept of the high-volume center and discuss the feasibility of applying this concept to low and middle-income nations. Specifically, we discuss a modification of this concept that may be considered when incorporating PD into low-volume and resource-poor countries, such as those in the Caribbean. This paper has two parts. First, we performed a literature review evaluating studies published on outcomes after PD in high volume centers. The data in the Caribbean is then examined and we discuss the incorporation of this operation into resource-poor hospitals with modifications of the centralization concept. In the authors’ opinions, most patients who require PD in the Caribbean do not have realistic opportunities to have surgery in high-volume centers in developed countries. In these settings, their only options are to have their operations in the resource-poor, low-volume settings in the Caribbean. However, post-operative outcomes may be improved, despite low-volumes, if a modified centralization concept is encouraged.

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Review of minimally invasive pancreas surgery and opinion on its incorporation into low volume and resource poor centres

Cited by 13 publications

References 72 publications

Surgical Outcomes of Pancreatic Solid Pseudopapillary Neoplasm: Experiences of 24 Patients in a Single Institute

Surgical Outcomes of Pancreatic Solid Pseudopapillary Neoplasm: Experiences of 24 Patients in a Single Institute

Successful laparoscopic resection of a rare focal form of congenital hyperinsulinism: Case report and literature review

Whipple’s operation with a modified centralization concept: A model in low-volume Caribbean centers

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