Distal Pancreatectomy Group Research Articles

Better preservation of endocrine function after central versus distal pancreatectomy for mid-gland lesions

Traditional resections for benign and low-grade malignant neoplasms of the mid pancreas result in loss of normal parenchyma that can cause pancreatic endocrine and exocrine insufficiency. Central pancreatectomy (CP) is a parenchyma-sparing option for such lesions. This study evaluates a single institution's experience with CP and compares outcomes with distal pancreatectomy (DP). We retrospectively collected data on CP patients from 1997 through 2009 and evaluated outcomes. In a subset of 50 patients, we performed a matched-pairs analysis to directly compare the short- and long-term outcomes of CP and DP. Seventy-three patients underwent CP with a median operating room time of 254 minutes. Overall morbidity was 41.1% with pancreatic fistula in 20.5%. Mortality was 0%. There were no differences in fistula, morbidity, and mortality rates between the CP and DP groups. The CP group had resected for smaller lesions. CP patients had a lower rate of new-onset and worsening diabetes than DP patients (14% vs 46%; P = .003). Of new-onset and worsening diabetics, only 1 CP patient required insulin compared with 14 DP patients (P = .002). CP is safe and effective for select neoplasms of the mid pancreas. Patients undergoing CP have markedly decreased insulin requirements compared with DP patients.

Effect of Pancreaticoduodenectomy on the Course of Hepatic Steatosis

The progression of hepatic steatosis after pancreaticoduodenectomy (PD) is controversial. This study was designed to determine whether PD would influence the course of hepatic steatosis. Patients admitted for PD and distal pancreatectomy (DP) from January 2004 to January 2008 were enrolled. Exclusion criteria included liver metastasis, severe obesity (body mass index >30), diabetic mellitus, excessive alcohol consumption, and unavailable preoperative and 6-month postoperative unenhanced CT images. The pre-PD and post-PD liver attenuation, ratio, and difference of liver-to-spleen attenuation between liver and spleen attenuation were compared. Fifty patients who underwent PD and 20 patients who underwent DP were eligible. The mean follow-up period was 18.2 +/- 1.6 months for the PD group and 19.7 +/- 1.7 months for the DP group. Liver attenuation after PD was significantly decreased from 52.3 +/- 1.1 H. to 47.6 +/- 2 H. (p = 0.044), but no difference was observed in spleen attenuation. The liver-to-spleen attenuation ratio after PD also was significantly decreased: 1.12 +/- 0.02 versus 1.01 +/- 0.04 (p = 0.033). No difference in liver attenuation was found in the DP group. The female gender was a significant risk factor. The liver attenuation of CT images decreases in patients who receive PD, which implicates that hepatic steatosis can develop after PD; however, the mechanism needs to be elucidated.

Distal Pancreatectomy Combined with Celiac Axis Resection in Treatment of Carcinoma of the Body/Tail of the Pancreas: A Single-Center Experience

Few comparison studies have been carried out on patients with distal pancreatectomy (DP) combined with celiac axis (CA) resection. The aim of this study was to assess the safety and efficacy of this extended procedure in treatment of advanced carcinoma of the body/tail of the pancreas. This was a retrospective analysis of 206 patients with carcinoma of the body/tail of the pancreas from January 2003 through June 2008. Patients were divided into three groups based on the relationship of tumor and CA/common hepatic artery (CHA) as well as different treatment strategies. Data for operation time, blood loss, complications, and survival time were collected and statistically analyzed. Sixty-five patients (31.6%) received radical distal pancreatectomy (DP), including 11 patients who underwent DP combined with celiac axis resection (group A) and 54 patients who received conventional DP (group B). Twenty patients did not undergo DP because of CA and/or CHA invasion only (group C). Group A had longer mean operative time than group B (323 versus 225 min, P = 0.000); there was no difference in mean estimated blood loss, percentage of pancreatic fistula or median survival time (14 versus 15 months, P = 0.197). However, group A had significantly prolonged median survival time compared with the 20 patients in group C (14 versus 5 months, P = 0.013), and quality of life was also dramatically improved. DP combined with CA resection can be safely performed in certain patients with carcinoma of body/tail of the pancreas and significantly improves patient survival and quality of life.

A Central Pancreatectomy for Benign or Low-Grade Malignant Neoplasms

InctroductionA central pancreatectomy is a parenchyma-sparing procedure that is performed to reduce long-term endocrine and exocrine insufficiency. MethodIn this study, we analyzed the perioperative course, the frequency of postoperative onset of diabetes mellitus, and long-term change of body weight in patients undergoing a central pancreatectomy, in comparison to the patients undergoing a distal pancreatectomy for low-grade neoplasms including cystic neoplasms and neuroendocrine tumors. Results and DiscussionThe rate of postoperative complications including grade B/C pancreatic fistula was no different between both groups. Only one patient undergoing a central pancreatectomy (4.7%) developed new onset of mild diabetes, whereas 35% in the distal pancreatectomy group developed new onset or worsening diabetes (p = 0.0129). The body weight in the distal pancreatectomy group was significant lower than that in the central pancreatectomy group at 1 and 2 years after surgery (1 year; P < 0.0001, 2 years; P = 0.0055), and the body weight in the patients undergoing a central pancreatectomy improved to preoperative values within 2 years after surgery. ConclusionA central pancreatectomy is a safe procedure for the treatment of low-grade malignant neoplasms in the pancreatic body; the rate of onset of diabetes is minimal, and the body weight improves early in the postoperative course.

Early experience with laparoscopic resections of islet cell tumors

Diagnostic laparoscopy and laparoscopic ultrasonography have been applied recently for diagnosis and localization of islet-cell tumors. A further step was taken by performing resection of these tumors with laparoscopic techniques. We studied a retrospective series of 12 patients operated on with laparoscopic techniques since January 1992. The seven female and five male patients had a mean age of 43 years. The mean tumor size was 3 cm. Thirty-six percent of the tumor site could not be identified before operation. Eight patients underwent planned laparoscopic distal pancreatectomy (five insulinomas, two gastrinomas, and one unknown origin), and four underwent planned laparoscopic enucleation (one insulinoma and three unknown origin). Of the eight distal procedures, three had conversions (one inability to localize the tumor and two metastatic gastrinomas). Average operating time was 4.5 hours, with an average hospital stay of 5 days. Of the four explorations for possible enucleation, one was performed and one was converted to a Whipple procedure for nesidioblastoma of the head of the pancreas. The other two had negative explorations. The successful enucleation of an insulinoma of the anterior body of the pancreas was performed in 3 hours, and the hospital stay was 4 days. No recurrence was seen in the enucleated or distal pancreatectomy group in follow-up (15 to 38 months). Laparoscopic enucleation or resection of benign islet tumors results in a shorter hospital recovery and is a good alternative to open surgery.