Central Pancreatectomy Research Articles

Robotic central pancreatectomy with pancreaticogastrostomy for solid pseudopapillary tumor

Aims: Central pancreatectomy is a viable option for the removal of benign and low-grade malignant tumor located at the body and neck of the pancreas which are not suitable for enucleation. This video describes the technique of robotic centra pancreatectomy with pancreaticogastrostomy. Methods: A 24-year-old woman with no previous medical history was incidentally diagnosed with a solid tumor of the body of the pancreas. MRI demonstrated a 2-centimeter mass with upstream duct dilatation and EUS-guided FNA confirmed the suspicion of solid pseudopapillary tumor (SPT). Results: Four robotic trocars were placed along the transumbilical line (two on the left, one supraumbilical and one on the right flank, spaced at least 8 cm from each other). Two additional assistant laparoscopic trocars were placed caudal to the previous ones. Robotic central pancreatectomy was performed with a stapler section of the cephalad pancreatic margin. After wide mobilization of the distal pancreatic stump and a running, single-layered pancreaticogastrostomy was performed. The postoperative course was uneventful although a biochemical leak was detected. The patient was discharge on day 11 and surgical drains were removed on day 7 and 19. Pathology confirms the diagnosis of SPT with negative margin and no lymph nodes involved (N0/11). Conclusions: In the setting of a high-volume center, central pancreatectomy is associated with good short-term surgical morbidity and it can be achieved with minimally invasive approach. Pancreaticogastrostomy is a valid reconstruction option and avoids an additional anastomosis.

Central pancreatectomy - our experience in a tertiary care centre in Southern India

Background: Pancreatic benign and low grade malignant tumors located in the body and neck of pancreas pose a challenge to surgeon for extent of pancreatic resection. The study was to done to evaluate the role of central pancreatectomy in intermediate located tumors.

Solid Pseudopapillary Neoplasm: Single Center Experience

Purpose: Solid Pseudopapillary Neoplasm(SPN) was first described by Frantz in 1959. SPNs are very rare tumors about 0.3-2.7% of all pancreatic tumors, and therefore the management of disease is still controversial. In this study, we aimed to present our experience together with literature review. Method: We reviewed hospital medical records from January 2005 to February 2020. Patient data was collected retrospectively. Study was approved by local Ethics Committee. Results: In our institution, there were 15 SPN patients (4.7%) among 319 pancreatic mass. Median age was 36 (mean 35.6, range 11-70) and all were female. Median follow-up was 81 months (mean 74.6, range 18-160) and there was no long term mortality. Eight distal pancreatectomy (DP), five pancreaticoduodenectomy (PD), one total pancreatectomy (TP) and one central pancreatectomy (CP) were performed. Distant metastases or peritoneal implants were not observed during surgery and only one patient had lymph node metastasis. There was no postoperative mortality and one reoperation was performed after DP due to pancreatic leak. Abdominal abscess (two patients) and pancreatic fistulas (three patients) developed as postoperative complications. Although four of the patients (3 DP, 1 PD) had microscopic tumor residual on surgical margin, distant metastasis or local recurrence were not observed at any of the patients during long term follow-up. Conclusion: Even-though there is a risk of distant metastasis, there have been no consensus for surgical management of SPN. Many studies suggest that surgical treatment should be chosen according to oncological principals similar to other pancreatic malignancies. Consistent with the literature, we performed oncologic surgery for SPN according to tumor location in the pancreas. In our experience, SPN has excellent prognosis even with positive surgical margin, so pancreas-sparing surgeries such as enucleation may be considered in anatomically suitable patients. However prospective randomized controlled trials are still missing due to rarity of SPN. Designing multi-centric studies may overcome this problem in the future.

An outcome analysis of central pancreatectomy: a single centre experience

Introduction: Central pancreatectomy is a pancreatic resection procedure for selected pancreatic lesions. Literature reveals a higher pancreatic fistula rate compared to Whipple procedure and distal pancreatectomy. This study highlights our indications, technique and outcomes of this procedure.

Robotic central pancreatectomy for a solid pseudopapillary neoplasm

Introduction: Solid pseudopapillary neoplasms (SPN) are a rare entity that mostly occurs in young women. For its malignant potential, the standard treatment is surgery. Robotic surgery offers more accuracy and range of movement, facilitates the dissection the pancreas and increases the rate of splenic vessels preservation. Methods and Results: We present the case of a 30-year-old women diagnosed of an incidental pancreatic cystic neoplasm in a Computed Tomography scan. A Magnetic Resonance and an Endoscopic Ultrasound confirmed the diagnosis. The intervention was performed with the DaVinci Xi. Three 8mm and one 12mm robotic ports and one 12mm laparoscopic port were placed. The gastrocolic ligament was dissected with access to the lesser sac. An intraoperative ultrasonography was performed with visualization of the lesion limited to the pancreatic body. The pancreatic neck was divided with an endostapler, the body was dissected reaching the distal margin of the SPN and also divided at that level. Intraoperative pathology report confirmed negative margins. The splenic vessels were identified and preserved. Reconstruction was performed with a pancreato-gastric anastomosis. During the postoperative course, the patient presented upper gastrointestinal bleeding exteriorized as melena. Blood transfusion and an upper gastrointestinal endoscopy with electrocauterization of an arteriolar bleeding of the pancreas were required. The patient remained hemodynamically stable. No pancreatic fistula occurred. The patient was discharged on postoperative day 14. Conclusion: Central pancreatectomy is a parenchyma-sparing procedure that can be used in pancreatic lesions limited to the neck/body. Robotic surgery offers major precision in order to dissect and preserve splenic vessels and helps in a more accurate and tight anastomosis.

Surgery of pancreas tumors in children and adolescents: a single institution experience

Purpose: The aim of this study is the surgical management and the clinical and pathological features of patients who underwent pancreatic resection for benign and malignant pancreatic tumors in childhood and adolescence and described the morbidity and mortality of this group of patients. Methods: This is a retrospective review of medical reports of patients ≤19 years with pancreatic tumors who underwent surgery in National Cancer Center, Lima, Peru from January 2000 to January 2019. Results: Thirty-two patients underwent surgery, the mean age was 13.65 years (3-18), 26 patients were women and 6 men. The tumor location was in the head (n = 18), tail (n = 9) and body (n = 5), the mean tumor size 7.34cm (2-13.5cm). The histological types were: solid pseudopapillary tumor (SSP) (n = 27), pancreatoblastoma (n = 3) and neuroendocrine tumor (n = 2) of which one was neuroendocrine carcinoma and another insulinoma. All tumors had R0 in bloc resection, surgical treatment was: pancreaticoduodenectomy (n = 18), distal pancreatectomy (n = 9), central pancreatectomy (n = 4) and tumor enucleation (n = 1). The survival rate according to 5-year Kaplan Meier analysis was 74%. The median duration of follow-up was 33 months. The postoperative mortality was 0%. Conclusions: Radical surgery is a safe treatment in patients with primary tumors of the pancreas with a low mortality rate and postoperative complications. The SSP is the most frequent pathology with a good prognosis.

Robotic Pancreatic Surgery, Single Institution’s Experience at a High Volume Minimally Invasive Center

Introduction: Minimally invasive pancreas resection has seen rapid development in the past decades, incorporating robotic approach. Robotic pancreatic surgery (RPS) seems to be a safe and feasible option for all types of pancreatic surgery. The purpose of this study is to summarize our experience in this field at a high volume minimally invasive center. Methods: All patients undergoing RPS at Germans Trias Hospital, between April 2018 and December 2020 were analyzed from a prospective database. Clinicopathologic features, perioperative and oncologic outcomes were assessed. Results are expressed as percentage and mean (interquartile range). Results: During the study period a total of 64 minimally invasive surgeries were performed, of which 32 were RPS. 6 Pancreatoduodenectomies, 18 Robotic distal pancreatectomies (4 spleen-preservation), 6 parenchyma-sparing and 2 central pancreatectomies. Sex ratio was, 12 males to 20 females, mean age was 66,4 years (38-78). American Society of Anesthesiologists (ASA) score was 43,7% ASA 2, 40,2% ASA 3 and 16,1% ASA 4, body mass index of 27,7 Kg/m2 (21-35,8), pancreatic fistula rate of 18,7% (12,5 biochemical leak and 6,2% grade A), intraoperative blood loss 183,3 cc (150-450). Conversion was mandatory in 6 cases (18,7%), hospital length-stay was 6,7 days (5-21), Dindo-Clavien ≥3 21,8%. Readmission and reintervention rates were 12,5 and 9,3%, respectively. Oncologic outcomes in malignant cases were as follows; mean lesion size 26,7 mm (12-42mm), R0 resection 87,5%, mean lymph node yield 13,6 (6-26). Conclusion: In our experience, robotic pancreatic surgery is safe and feasible in well-selected patients. Surgical planning and stepwise implementation based on previous experience could help to face this technical demanding procedures, providing the benefits of robotic surgery.

Laparoscopic Central Pancreatectomy: Results in 81 Patients

Introduction: Central pancreatectomy (CP) is a good indication to the laparoscopic approach related to the absence of oncological or vascular contraindications. The aim of this study was to analyze our monocentric experience.

Risk factors associated with recurrence of pancreatic solid pseudopapillary neoplasms: a single institution experience

Background: Pancreatic solid pseudopapillary neoplasms are rare and low-grade tumors. The milestone of treatment is surgical resection, however, some patients relapse after surgery. The aim of this study is to analyze the clinical and pathological features associated with increased risk of recurrence in SPN. Methods: Between 2000 and 2019 seventy-four patients with SPN underwent surgical resection and then were followed up periodically. Clinicopathological data were statistically analyzed. Results: Of the 74 total patients, 70 (94.6%) were women and 4 (5.4%) were men. The median age was 25.1 (range, 7-68 years). The median tumor size was 8.7 (range, 2-20 centimeters) and the tumor localization was: head (n= 35), body (n=16) and tail (n= 23). The surgical treatment was: duodenopancreatectomy (n=32), central pancreatectomy (n=9) and distal pancreatectomy (n= 33). For patients with R0 resection, the Kaplan Meier five years survival was 87%. The five-year rate of locoregional tumor recurrence was 6.7%. The presence of larger tumors size (diameter>5cm), perineural invasion, lymph node metastasis, positive margins, and multi-visceral resection were significant factors for locoregional recurrence and cancer-related survival. Conclusions: Factors including a larger tumor size (diameter > 5cm), perineural invasion, lymph node metastasis, positive margins, and multi-visceral resection may increase the risk of recurrence of resected SPNs.

Resection of the splenic vessels during laparoscopic central pancreatectomy is safe and reduces the risk of post-operative haemorrhage

Purpose: Low potential malignant diseases are more frequently discovered and laparoscopic central pancreatectomy (LCP) can be indicated. LCP usually preserving splenic vessels (LCP-PreSV), allows a low-risk of new onset diabetes at the expense of a high morbidity represented mainly by post-operative pancreatic fistula (POPF) and bleeding. In this study, we evaluated the impact of the splenic vessels resection (LCP-ResSV) on short and long term complications. Methods: Of 650 laparoscopic pancreatic resections from 2011 to 2020, 84 LCP were performed, including 15 LCP-ResSV and 69 LCP-PreSV. The 15 CPL-ResSV were matched [1:2] with 30 CPL-PreSV according to age, sex, BMI and tumor characteristics (neuroendocrine tumor, mucinous cystadenoma, intraductal papillary mucinous neoplasm, solid pseudopapillary neoplasm, cyst, others). Pancreatogastric anastomosis was achieved in all patients and patients were discharged after healing of complications. Both groups (LCP-ResSV vs LCP-PreSV) were compared. Results: In the LCP-ResSV, splenic vessels resection were performed related to tumoral or inflammatory adhesions (n=11) and accidental vascular injury (n = 4). There was no difference regarding demographics data. The tumour size was larger in LCP-ResSV (40mm vs 21mm; p = 0.008) and the right transection was more frequently done on the body (53% vs 13%; p=0.01). There was no difference in pancreatic characteristics (Wirsung duct size and consistency). The median operative time was longer in LCP-ResSV group (210 min vs 180 min ; p=0.15) with more blood loss (100 mL vs 50 mL ; p=0.012). The lengths (mm) of the resected pancreas and remnant distal pancreas were 65mm vs 50mm (p=0.053) and 40mm vs 65mm (p=0.006), respectively. There were no differences regarding post-operative mortality (0% vs 3% ; p = 0.47), grade B-C POPF (27% vs 27% ; p = 1), re-intervention (7% vs 13% ; p = 0.50); grade B-C bleeding (0% vs 13%; p = 0.13), length of hospital stay (20 days vs 22 days; p = 0.15) and new onset diabetes (7% vs 10%; p = 0.67). Conclusion: LCP-ResSV is a safe technical modification of central pancreatectomy with no impact on pancreatic fistula risk or endocrine insufficiency, compared to LCP-PreSV. Furthermore, it could reduce the risk of post-operative haemorrhage.

Robotic central pancreatectomy for neuroendocrine tumor (NET) in a patient with a Roux-en-Y Gastric Bypass (RYGB)

Purpose: We present the case of a 45 years old patient with a diagnosis of a single resectable 12mm histologically proved G1 NET of the pancreatic isthmus. Method: In her past medical hystory we notice a laparoscopic gastric by-pass was performed for morbid obesity. Pre-operative work-up included pancreatic MRI, thoracic CT-scan and blood exams. Chromogranine A was within limits. After multidisciplinary discussion either resection or surveillance were conceived considering size and grading, the patient preferred surgical resection in order to avoid life-long surveillance and because of the fear of having a pancreatic lesion potentially evolving. A robotic minimally invasive approach was then considered, the surgical strategy focused on the distal pancreatic stump anastomosis. Results: Intraoperative ultrasound confirmed the absence of other pancreatic lesions. A pancreatico-gastric anastomosis was performed on the excluded stomach, tutored by an Escat drain exteriorized according to Voelker. Post-operative course was uneventful, the patient was discharged on postoperative day 9 (POD9),Pathological findings: grade 1 well-differentiated neuroendocrine tumor, Ki-67 index <1%, R0 (complete resection) Escat drain clamped on POD 14 and withdrawn 1 month after the operation. Conclusion: robotic central pancreatectomy allowed a very precise dissection with the possibility of an ergonomic pancreatico-gastric anastomosis.

Learning curve analysis of 73 cases of central pancreatectomy

Objective: To explore the learning curve of central pancreatectomy (CP) and provide an excellent reference for surgeons to get the point of this operation. Methods: Clinical data of 73 patients who underwent CP in the same operation team from January 2006 to January 2018 were collected and retrospectively analyzed by the moving average method (MAM) and the cumulative sum method (CUSUM). Data was analyzed by statistical package for social science (SPSS) software. Results: According to the MAM and CUSUM curves, the learning process of CP could be divided into two stages. At the first stage (n=1-11), the median operation time was 340 minutes and the median intraoperative hemorrhage was 400 ml. In the second stage (n=12-73), the median operation time was 213 minutes and the median intraoperative hemorrhage was 100 ml. The difference was statistically significant (P<0.001). There were no significant differences between the two stages of patients in terms of other aspects (P>0.05). Conclusions: CP can be mastered after 11 cases of exercises. In the first 11 operations, surgeons should get familiar with the operation process, respond actively to emergencies and accumulate experience to gain this surgical technique fast.

Postoperative Outcome of Surgery with Pancreatic Resection for Retroperitoneal Soft Tissue Sarcoma: Results of a Retrospective Bicentric Analysis on 50 Consecutive Patients

BackgroundsMultivisceral resection is the standard treatment for retroperitoneal sarcoma (RPS) during which pancreas resection may be necessary. MethodsAll consecutive patients operated for RPS with pancreatectomy in 2 expert centers between 1993 and 2018 were retrospectively analyzed. ResultsFifty patients (median age: 57 years, IQR: [46–65]) with a primary (n = 33) or recurrent (n = 17) RPS underwent surgery requiring pancreas resection (distal pancreatectomy (DP) (n = 43), pancreaticoduodenectomy (PD) (n = 5), central pancreatectomy (n = 1), and atypical resection (n = 1)). Severe postoperative morbidity (Clavien-Dindo III–IV) was observed in 14 patients (28%), and 7 of them (14%) required reoperation for anastomotic bowel leakage (n = 5), gastric volvulus (n = 1), or hemorrhage (n = 1). Pancreas-related complications occurred in 25 patients (50%): 10 postoperative pancreatic fistulas (POPF) (grade A (n = 12), grade B (n = 6), grade C (n = 1)), 13 delayed gastric emptying (grade A (n = 8), grade B (n = 4), grade C (n = 1)), 1 hemorrhage (grade C). Postoperative mortality was 4% (n = 2), all following PD, caused by a massive intraoperative air embolism and by a multiple organ failure after anastomotic leakage. Pathological analysis confirmed pancreatic involvement in 17 (34%) specimens. Microscopically complete resection (R0) was achieved in 22 (44%) patients. After a follow-up of 60 months, 36 patients (75%) were still alive, among whom 27 without recurrence (56%). ConclusionPancreatic resection during RPS surgery is associated with significant postoperative morbidity and mortality. PD should be avoided whenever possible while other procedures seemed achievable without excessive morbidity and with long-term survival.

Robotic pancreaticoduodenectomy and splenopancreatectomy: technical aspects and review of literature

Robotic pancreatic surgery provides several advantages. Since the first report of a robotic-assisted distal pancreatectomy in 2001, total pancreatectomies, pancreatic tumor enucleations, pancreaticoduodenectomy, central pancreatectomy and Appleby procedures have been performed, indicating a promising future. The aim of this article is to describe our experience of robotic pancreatic surgery including technical aspects for pancreaticoduodenectomy and distal pancreatectomy. The current literature on feasibility, safety and early postoperative outcomes will be discussed.

Surgical management of pancreatic pseudocyst: a single-center experience

Aim Pancreatic pseudocyst is the commonest cystic lesion of the pancreas. It usually develops on a background of pancreatitis. Cyst recurrence is the most feared complication following surgical management of pancreatic pseudocyst. Patients and methods The authors reviewed the data of 48 patients who were managed surgically during the period between 2010 and 2019. Results Biliary pancreatitis was the commonest cause (24 cases − 50%). The mean cyst size was 13.5±6.4 cm (6–42 cm). Most lesions were located in the body and tail of the pancreas (32 cases − 66.7%). Open approach was performed in 45 (93.8%) cases whereas the remaining cases were performed laparoscopically. Cases were managed by cystogastrostomy (39 cases − 81.3%), cyst-jejunostomy (seven cases − 14.6%), combined procedures (one case − 2.1%), or central pancreatectomy (one case − 2.1%). Cholecystectomy was performed in 17 (35.4%) cases. Early postoperative morbidity was encountered in nine (18.8%) cases. After a median follow-up of 68 months, no recurrence was detected. One (2.1%) case developed incisional hernia, and another one (2.1%) had adhesive intestinal obstruction. Conclusion Surgical intervention for pancreatic pseudocysts is a safe and feasible approach. It offers the ability to deal with the primary cause during operation and excellent long-term outcome regarding pseudocyst recurrence.

Rare adult pancreatic hemangioma: review of the literature with a case report

Adult pancreatic hemangioma is an especially rare benign tumor that is hard to diagnose through imaging examinations, meanwhile its histopathological and immunohistochemical studies have rarely been reported. At this time, only 29 cases in 27 publications have been reported. We report a new case as well as review these literatures. A 71-year-old woman came to our hospital with slight pain on left upper abdomen for three days. But the results obtained from the physical or laboratory examination were all negative so that her symptoms could not be explained clearly. The imaging examinations including ultrasonography and computed tomography both showed a mixed mass in the neck of the pancreas. The preoperative diagnosis of cystadenoma or adenocarcinoma was made, with high suspicious of malignancy. The patient underwent a central pancreatectomy with pancreatojejunostomy, but the pathologic diagnosis was pancreatic hemangioma. The immunohistochemical examination found the positive benign vascular markers (CD31, CD34) and negative lymphocyte markers (D2-40). Moreover, Ki-67 negativity also revealed its benign nature. After 36 months of follow-up, the patient has no complaints for abdominal pain. In conclusion, adult pancreatic hemangioma is extremely rare without any specific clinical manifestations. It is usually diagnosed postoperatively by histological examination and immunohistochemical studies. Imaging examinations, including computed tomography and magnetic resonance imaging, can't give definite conclusion. Endoscopic-ultrasound guided fine needle aspiration is conditionally worth doing, which can give some hints and exclude the malignancy of the lesion. If malignancy can be safely ruled out, the surgical decision must be made according to risk-benefit analysist. Maybe close observation and regular follow-up are more beneficial options.

Laparoscopic-assisted distal gastrectomy and central pancreatectomy for gastric and perigastric lymph node metastases and pancreatic invasion from melanoma: a case report

BackgroundIn melanoma, completely resectable metastases are surgically resected to expect to prolong relapse-free survival and overall survival. However, distant metastases of melanoma are rarely indicated for surgery because multiple metastases are often observed at diagnosis. We report a case of a man in his 50s who underwent laparoscopic-assisted distal gastrectomy and central pancreatectomy for gastric metastases, lymph node metastases, and pancreatic invasion that could be completely resected.Case presentationA 50-year-old man was diagnosed with malignant melanoma of the left parietal region. After diagnosis, tumor resection and left cervical lymph node dissection were performed, and interferon-β treatment was added as adjuvant therapy. Seventeen months after adjuvant therapy, metastasis of stomach and abdominal lymph nodes from melanoma was diagnosed. And the pancreatic invasion of lymph nodes was suspected. Laparoscopic-assisted distal gastrectomy and the central pancreatectomy were performed because pancreatic invasion of melanoma was intraoperatively found. After 9 months of relapse-free survival, abdominal recurrence was observed. Nivolumab and ipilimumab were administered, and recurrent lesions are currently controlled. The patient has survived more than 3 years since metastasis resection.ConclusionIn conclusion, laparoscopic-assisted distal gastrectomy and the central pancreatectomy were performed for gastric and perigastric lymph node metastases and pancreatic invasion due to malignant melanoma, and the negative surgical margin was achieved. Although patient selection is required, the central pancreatectomy was a good indication for maintaining exocrine and endocrine function. The development of immune checkpoint inhibitors and molecular-targeted agents may increase gastrointestinal surgery for metastatic melanoma in the future.

Clinical analysis of minimal invasive surgical treatment for pancreatic neuroendocrine tumors

Objective: To analyze the safety and effectiveness of minimal invasive surgery treating pancreatic neuroendocrine tumors (pNETs), and to summarize surgical characteristics and share experience. Methods: The clinical data of 80 pNETs treated by a single hospital from January 2015 to December 2019 were retrospectively analyzed. The patients were divided into laparoscopic group and robot group. And surgical procedures included pancreaticoduodenectomy (PD), distal pancreatectomy (DP), central pancreatectomy (CP), and tumor enucleation. Results: Of 80 patients, 76 cases (95%) underwent minimal invasive surgery and 4 cases (5%) changed to open surgery. There were 38 females, with median age of 54.4 (20-80) years and median BMI (17.0-38.0) kg/m(2). Among them, 24 patients (31.6%) underwent PD, 36 patients (47.4%) underwent DP, 8 patients (10.5%) underwent CP and 8 patients (10.5%) received tumor enucleation. The postoperative incidence of grade B/C pancreatic fistula was 35.5%, the incidence of abdominal infection was 10.5%, the postoperative bleeding was 7.9%, and the reoperation rate was 6.6%, without perioperative deaths. There was no significant difference in postoperative complications among different surgical methods, including postoperative pancreatic fistula (P=0.396), postoperative bleeding (P=0.297), postoperative abdominal infection (P=0.339) and reoperation (P=0.396). Conclusions: Surgical resection is an effective treatment for pNETs. pNETs are suitable for minimally invasive surgery with earlier stage and smaller tumor diameter. Minimally invasive surgery for pNETs is safe and feasible, and functional preserving surgery could take into consideration.

Short- and Long-Term Outcomes of Laparoscopic Organ-Sparing Resection for Pancreatic Neuroendocrine Neoplasms.

Pancreatic neuroendocrine neoplasms (PNENs) are rare neoplasms associated with a long life expectancy after resection. In this setting, patients may benefit from laparoscopic organ-sparing resection. Studies of laparoscopic organ-sparing resection for PNENs are limited. The aim of this study was to evaluate the short- and long-term outcomes of laparoscopic organ-sparing resection for PNENs. A retrospective study was performed for patients with PNENs who underwent laparoscopic organ-sparing pancreatectomy between March 2005 and May 2018. The patients' demographic data, operative results, pathological reports, hospital courses and morbidity, mortality, and follow-up data (until August 2018) were analysed. Thirty-five patients were included in the final analysis. There were 9 male and 26 female patients, with a median age of 46years (range 25-75years). The mean BMI was 24.6 ± 3.3kg/m2. Nine patients received laparoscopic enucleation (LE), 20 received laparoscopic spleen-preserving distal pancreatectomy (LSPDP), and 6 received laparoscopic central pancreatectomy. The operative time, intraoperative blood loss, transfusion rate, and postoperative hospital stay were 186.4 ± 60.2min, 165 ± 73.0ml, 0days, and 9days (range 5-23days), respectively. The morbidity rate, grade ≥ III complication rate, and grade ≥ B pancreatic fistula rate were 34.2%, 11.4%, and 8.7%, respectively, with no mortality. The rate of follow-up was 94.3%, and the median follow-up time was 55months (range 3-158months). One patient developed recurrence 36months after LE and was managed with surgical resection. The other patients survived without metastases or recurrence during the follow-up. One patient had diabetes after LSPDP, and no patients had symptoms of pancreatic exocrine insufficiency. Nineteen patients who underwent LSPDP (16 with the Kimura technique and 3 with the Warshaw technique) were followed. Normal patency of the splenic artery and vein was observed in 14 and 14 patients within 1month of surgery and in 15 and 14 patients 6months or more after the operation, respectively. Partial splenic infarction was observed in 3 patients within 1month of surgery and in no patients 6months or more after the operation. Three patients eventually developed collateral venous vessels around the gastric fundus and reserved spleen, with one case of variceal bleeding. Laparoscopic organ-sparing resection for selected cases of PNENs is safe and feasible and has favourable short- and long-term outcomes.

Robotic Surgery for Pancreatic Serous Cystadenoma: Analysis of 148 Cases

To investigate the clinical efficacy of robotic surgery for pancreatic serous cystadenoma. There were 148 patients with pancreatic serous cystadenoma underwent robotic surgery from April 2015 to June 2019 in our department, the clinical data including intraoperative data, perioperative complications, and histopathological results were retrospectively analyzed. Among the 148 patients, there were 39 cases (26.4%) of the tumors located in pancreatic head, 15 cases (10.1%) in pancreatic neck and 94 cases (63.5%) in pancreatic body and tail. Pancreaticoduodenectomy, distal pancreatectomy, central pancreatectomy, and enucleation were performed in 26 cases (17.6%), 71 cases (48.0%), 24 cases (16.2%) and 27 (18.2%) cases, respectively. The incidence of serious postoperative complications were 7.7%, 2.8%, 0, 0, respectively, and grade B pancreatic fistula were 7.7%, 7.0%, 41.7%, 14.8%, respectively. 90-day mortality was 0. Compared with pancreaticoduodenectomy, enucleation of the pancreatic head tumor had shorter operation time ( P<0.001), less intraoperative blood loss ( P<0.001), and shorter length of hospital stay ( P<0.001). Compared with central pancreatectomy+pancreaticojejunostomy, Rong central pancreatectomy had shorter operation time ( P=0.007) and length of hospital stay ( P=0.040). Robotic surgery for pancreatic serous cystadenomaisis safe and feasible. Rong central pancreatectomy for serous cystadenoma in middle segmental pancreas could achieve feasible results.