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Pancreatectomy for hyperinsulinism
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
The laparoscopic approach has two limitations: Tactile feedback is not available for the palpation of deep non-visible focal lesions, and intraoperative ultrasound cannot be performed adequately via a small laparoscopic port to evaluate the location of the pancreatic duct. The dissection and resection of the pancreatic tail and body for a distal pancreatectomy is relatively straightforward (Figure 64.13). The small vessels that arise from the splenic artery and vein are carefully cauterized with monopolar current, and the pancreas is ligated proximally to the desired area of transection with one or two loop ties.
HPB Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
London Lucien Ooi Peng Jin, Teo Jin Yao
If surgery was considered what would the operation be and what are the considerations?A lesion in the body of pancreas can still be addressed by a distal pancreatectomy. This can be achieved either laparoscopically or via an open approach. The main consideration will be whether the spleen is preserved or removed concomitantly as an enbloc resection. Lymphatic drainage from pancreatic body and tail lesions drain towards the splenic hilum. As such, if malignancy is highly suspected, then lymphadenectomy will need to include clearing the lymph nodes at the splenic hilum and thus entail a splenectomy. If splenectomy is planned, preoperative prophylactic immunisation is required to reduce the risk of future overwhelming post-splenectomy infection (OPSI).
Chronic Pancreatitis: Small Duct Disease with Uncontrolled Pain
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Michael F. Nentwich, Jakob R. Izbicki
In case of a dominant head mass in small duct pancreatitis, a pancreatoduodenectomy was initially the preferred approach. However, nowadays, the duodenum-preserving pancreatic head resection and its modifications are more commonly performed. Distal pancreatectomy seems to be beneficial only in a small subset of patients with disease limited to the body and tail of the pancreas. Near-total pancreatectomies failed to achieve a satisfactory pain relief along with severe pancreatic functional loss and should therefore be considered last.
Current status of robotic surgery for hepato-pancreato-biliary malignancies
Published in Expert Review of Anticancer Therapy, 2022
Marcus Bahra, Ramin Raul Ossami Saidy
‘Conventional’ minimally invasive oncological pancreas surgery cannot be seen as standard, although numerous retrospective studies indicate comparable outcomes (R0 resection, lymph node harvesting). The laparoscopic approach has been explored - as reconstruction is unnecessary - especially for distal pancreatectomy (DPR). Here, the results for short-term oncological outcomes (margin-free resection, lymph node harvesting) were comparable or improved (postoperative complications, quality of life or intraoperative blood loss) in laparoscopic procedures. At the same time, the operative time was generally longer [23]. Of importance, obesity still often remains a relative contraindication for the laparoscopic approach [24–26]. For duodenopancreatectomy (PDR) and total pancreatectomy (TPR), data are less favorable or scarce [24,27–29]. Thus, recommendations for minimally invasive pancreas surgery for neoplasms acknowledge these techniques accordingly [26].
When a metastatic breast cancer is mimicking a pancreatic cancer: case report and review of the literature
Published in Acta Clinica Belgica, 2020
Françoise Derouane, Jean-Cyr Yombi, Jean-François Baurain, Etienne Danse, Mina Komuta, Halil Yildiz
The treatment of pancreatic metastases depends on different criteria as nature of the primary tumor, widespread disease and the general state of health of the patient. Even if no guidelines have been established, an isolated pancreatic metastases may, in some conditions, be removed by surgery with successful outcome, even in breast carcinoma [2,6]. In our review, 36 cases had surgery treatment, and in these cases, 21 cases benefited from pancreaticoduodenectomy and 6 cases from distal pancreatectomy. In 23 cases, patient underwent chemotherapy or hormonotherapy regimen alone or as adjuvant treatment after pancreatic surgery. The average overall survival (OS), all treatment include, (in the cases where it was described [n = 32]) was 21 months (ranged from 0 to 72 months). Based on this review there was no significant difference in OS if the treatment was surgery alone, chemotherapy or homonotherapy alone, or a combination of surgery, chemotherapy/hormonotherapy and radiotherapy (OS with surgery alone: 26 months [on the 12 described cases] ranged from 4 to 60 months, OS for combination therapy: 20 months [on the 13 described cases] ranged from 2 to 72 months, OS for chemotherapy alone or hormonotherapy alone: 24 months [on the 4 described cases] ranger from 12 to 50 months).
Prediction of exocrine and endocrine insufficiency after pancreaticoduodenectomy using volumetry
Published in Acta Chirurgica Belgica, 2020
V. Hartman, B. Op de Beeck, T. Chapelle, B. Bracke, D. Ysebaert, C. De Block, G. Roeyen
The percentage of resected pancreas (Res%) and resection volume assessed with volumetry on CT has been used to predict the development of DM postoperatively by several authors. King et al. estimated that no more than 20%–25% of the normal residual pancreas was required to maintain clinically normal glucose homeostasis after distal pancreatectomy [20]. Pancreatic volumetric assessment has been described by Shirakawa et al. [2] for patients undergoing distal pancreatectomy. They found a resection of more than 44% of the pancreas to be an independent risk factor for the development of postoperative DM. They did not, however, perform function tests systematically before and after resection which may cause an underestimation of the number of patients with DM. Kwon et al. [19] found that Res% was predictive for postoperative DM in patients that underwent a distal pancreatectomy for a benign lesion. He describes a resection volume of more than 21.21 mL as a predictive factor (AUC = .67, sensitivity = 61%, specificity = 69%, OR 3.75 [95%CI 1.35–9.48]) and a Res% greater than 35.6% (AUC .69, sensitivity = 55%, specificity = 69%, OR 5.18 [95%CI 1.80–14.88]).