Distal Pancreas and Spleen-preserving Central Pancreatectomy in a Locally Aggressive Solid Pseudopapillary Neoplasm of Pancreas: A Novel Extended Warshaw Technique

N.R Vishnu Prasad,K.S Ashok,K.S Jayanth,C.K Sakthivel,G Mangala

doi:10.1016/j.hpb.2019.10.2188

N.R Vishnu Prasad, K.S Ashok + Show 3 more

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https://doi.org/10.1016/j.hpb.2019.10.2188

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Introduction: Central pancreatectomy (CP) is a well-described procedure done for neck and proximal body tumors of the pancreas. It can be done for benign lesions where an adequate length of the normal distal pancreas will be left leading to organ preservation. The currently described benefit of the procedure is decreased long-term morbidity due to retention of both the spleen and the preservation of functioning pancreas. This is usually dependent on the preservation of distal pancreatic vascularity by splenic artery preservation. Many studies have described splenic preservation by Warshaw technique by safeguarding the short gastric (SGA) and left gastroepiploic (LGEA) vessels in case of distal pancreatectomy. However, distal pancreatic preservation during CP with splenic vessels ligation is not given a significant mention in the current literature in relation to Warshaw technique Method: Here, we present a 19-year-old girl diagnosed with an exophytic solid pseudopapillary tumor of the pancreatic body that was selected for central pancreatectomy. In view of splenic vessels involvement, she underwent ligation of the splenic vessels and splenic preservation was based on the LGEA and SGA. Distal pancreas was anastomosed with a roux en loop of jejunum and intra-operatively, we were able to demonstrate the back flow in the splenic vessels. Result: Postoperative computed tomography showed adequate enhancement of the spleen along with retrograde blood flow into the distal splenic artery with enhancement of the distal pancreas. Her postoperative period went uneventful. Conclusion: Thus CP with extended Warshaw technique is a safe and feasible procedure where indicated.

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Preoperative prediction of the difficulty of surgery would be useful for surgeons embarking on minimally-invasive distal pancreatectomy(MIDP)
Distal pancreatic preservation during Central pancreatectomy (CP) with splenic vessels ligation is not given a significant mention in the current literature in relation to Warshaw technique Method: Here, we present a 19-year-old girl diagnosed with an exophytic solid pseudopapillary tumor of the pancreatic body that was selected for central pancreatectomy
In view of splenic vessels involvement, she underwent ligation of the splenic vessels and splenic preservation was based on the LGEA and short gastric (SGA)

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Invasive pancreaticoduodenectomy (MIPD) is being performed with increasing frequency for pancreatic cancer, but the most preferred and oncologically radical surgical platform, whether robotic or laparoscopic, is yet to be determined. Though operative time was slightly longer in the RPD arm, compared to the LPD , it was not statistically significant(p value-0.7).No statistical difference was observed between the two groups in terms of complication rate, mortality rate, R0 resection rate, number of harvested lymph nodes, median length of stay, 90-day mortality and 30-day readmission rate Conclusion: 15 cases of RPD were case matched with LPD on 1:1 basis; based on tumour location, tumour size and ASA grade. Though operative time was slightly longer in the RPD arm, compared to the LPD , it was not statistically significant(p value-0.7).No statistical difference was observed between the two groups in terms of complication rate, mortality rate, R0 resection rate, number of harvested lymph nodes, median length of stay, 90-day mortality and 30-day readmission rate [O-1742] LAPAROSCOPIC COMPLETION PANCREATECTOMY IS FEASIBLE AND SAFE.

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