Laparoscopic Central Pancreatectomy Research Articles

Sixteen cases of laparoscopic central pancreatectomy for benign or low-grade malignant tumours in the pancreatic neck and proximal body.

The purpose of this study is to examine and analyse the outcomes and patient experiences associated with laparoscopic central pancreatectomy. The perioperative data of 16 patients who underwent laparoscopic central pancreatectomy were retrospectively analysed at Ningbo Medical Center Lihuili Hospital (Xingning Branch and Eastern Branch) from September 2017 to July 2023. All surgical procedures were completed without the need for intraoperative conversion to open surgery. In two cases, intraoperative cholangiography was performed, while in four cases, intraoperative fluoroscopic laparoscopic assistance was utilized. The duration of the operations varied from 160 to 360 min, with an average of 281.75 min. The estimated volume of intraoperative bleeding ranged from 50 to 300 mL, with an average of 113.75 mL. The postoperative pathology results revealed that there were two cases of intraductal papillary mucinous neoplasm, six cases of serous cystic neoplasms, one case of mucinous cystic neoplasm, five cases of solid pseudopapillary neoplasms, and two cases of neuroendocrine tumours. The maximum diameter of the tumours ranged from 3.0 to 5.0 cm, with an average of 3.67 cm. There were no instances of postoperative common bile duct stenosis or biliary leakage. Among the cases, five did not exhibit pancreatic fistula, six experienced biochemical leakage, three had grade B pancreatic fistula, and two had grade C pancreatic fistula. Laparoscopic central pancreatectomy, as a method to preserve pancreatic function, entails specific surgical risks and a notable likelihood of postoperative pancreatic fistula, necessitating the expertise of seasoned surgeons for its execution.

Laparoscopic central pancreatectomy with splenic vein preservation

Laparoscopic central pancreatectomy with splenic vein preservation

Laparoscopic distal pancreatectomy versus laparoscopic central pancreatectomy for benign or low-grade malignant tumors in the pancreatic neck.

Laparoscopic distal pancreatectomy (LDP) and laparoscopic central pancreatectomy (LCP) are two surgical methods that can remove pancreatic neck lesions. However, their benefits remain controversial. We aimed to compare the benefits and limitations of LDP and LCP. In total, 50 patients who underwent LDP (n = 34) or LCP (n =16) between January 2014 and November 2019 were retrospectively reviewed using our database. We analyzed their preoperative characteristics, operative data, pathological features, and postoperative outcomes. The baseline features of patients did not differ significantly between the two groups (P < 0.05). Compared with the LDP group, the LCP group showed significantly prolonged operation time (392 ± 144 vs. 269 ± 130 min, P = 0.007), time to oral intake (3.8 ± 1.3 vs. 2.8 ± 0.9 days, P = 0.017), and hospital stay (19.6 ± 5.1 vs. 15.4 ± 4.1 days, P = 0.008) as well as increased hospital expenses (10.1 ± 6.2 vs. 6.6 ± 1.5 WanRMB, P = 0.023). However, no significant differences were observed in conversion rate (0/16 vs. 0/34), blood loss (154 ± 93 vs. 211 ± 170 mL, P = 0.224), postoperative white blood cell count (10.3 ± 2.7 vs. 11.1 ± 3.1, P = 0.432), first random blood glucose level after operation (8.2 ± 2.1 vs. 8.6 ± 2.6 mmol/L, P = 0.696), and ascites amylase level on day 3 after operation (5212 [3110-14,176] vs. 3142 [604-13,761] U/L, P = 0.167) between the two groups. Moreover, no significant differences were noted in the incidence of postoperative diabetes (1/16 vs. 5/34) between the two groups. However, LCP was associated with significantly higher incidences of pancreatic fistula grades B and C (P = 0.005) and postoperative hemorrhage (P = 0.031). Compared with the LCP, LDP is a useful and safer technique for benign or low-grade malignant tumors in the pancreatic neck.

Application of Simplified Duct-to-Mucosa Pancreaticojejunostomy for Nondilated Pancreatic Duct in Laparoscopic Pancreatic Surgery.

The objective of this study was to investigate the feasibility of simplified duct-to-mucosa pancreaticojejunostomy in a nondilated pancreatic duct in laparoscopic surgery. The data of 19 patients who underwent laparoscopic pancreaticoduodenectomy (LPD) and 2 patients who underwent laparoscopic central pancreatectomy were retrospectively analyzed. All patients underwent pure laparoscopic surgery successfully with simplified duct-to-mucosa pancreaticojejunostomy. The operation time of LPD was 365.11±41.56 minutes, the time of pancreaticojejunostomy was 28.39±12.58 minutes, and postoperative hospitalization time was 14.16±6.88 days on average. Postoperative complications occurred in 3 patients of LPD, including 2 cases of class B postoperative pancreatic fistula and 1 case of gastroparesis followed by gastrointestinal anastomotic perforation. The operative time of laparoscopic central pancreatectomy was 191.00±12.73 minutes, the time of pancreaticojejunostomy 36.00±5.66 minutes, and the postoperative hospitalization time 12.5±0.71 days on average. The described technique is a simple and safe reconstruction procedure and suitable for patients with nondilated pancreatic duct.

Major Venous Repair or Reconstruction During Laparoscopic Pancreatic Surgery: A Single Center's Experience.

Background: In pancreatic cancer surgery, tumor violation of blood vessels is often considered a contraindication to surgery, especially laparoscopic surgery. We have completed 17 cases of major venous repair or reconstruction during laparoscopic pancreatic surgery, and we believe that this surgical method may be safe and feasible based on the skilled laparoscopic techniques. Materials and Methods: Between January 2014 and March 2022, a prospective cohort of 17 patients underwent major venous repair or reconstruction in our department. Among them, 15 cases underwent laparoscopic pancreaticoduodenectomy, 1 case underwent laparoscopic distal pancreatectomy, and 1 case underwent laparoscopic central pancreatectomy. In all of these cases, the pancreatic tumor invaded either portal veins (PV) or superior mesenteric veins. Given these clinical situations, 13 cases accepted laparoscopic venous resection and reconstruction, and 4 cases underwent venous repair. Results: Ten of 17 patients (58.8%) were male. The mean age was 67.1 (range 57-81). All patients' operations were successfully completed without transit to open. The average blocking time of venous resection and reconstruction was 30.1 (range 15-41) minutes and the average time of venous wedge resection and stitching was 24.0 (range 18-30) minutes. After surgeries, there were no complications such as PV stenosis, bleeding, thrombosis, and liver failure. Thirteen patients died within 2 years because of the tumor recurrence, and 4 patients are currently followed by outpatient visits, with no obvious signs of tumor recurrence. Conclusion: Studies have shown that the reconstruction or repair of the major veins under laparoscopic surgery is safe and effective. We recommended that surgeons need to have the basics of open surgery in case laparoscopic surgery cannot be continued, and have proficient laparoscopic surgery techniques combined with extensive training to achieve a learning curve for vascular anastomosis. Clinical Trial Registration number: KY2021SL152-01.

Application of a sectional U-shaped reinforcement combined with penetrating pancreaticojejunostomy (U-PPJ) for soft pancreas in laparoscopic pancreatic surgery.

Laparoscopic techniques have been widely used in pancreatic surgery, such as laparoscopic pancreaticoduodenectomy (LPD) and laparoscopic central pancreatectomy (LCP). Laparoscopic pancreaticojejunostomy (LPJ) is a common procedure for LPD and LCP, and is also the most critical. The quality of LPJ is associated with the occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF). Although LPJ technology has been greatly improved, CR-POPF cannot be completely avoided especially to soft pancreas, which is an important reason for the high risk of laparoscopic pancreatic surgery. To date, there is a lack of standard LPJ approaches. Here, we report a U-shaped suture reinforcement for soft pancreatic section combined with penetrating pancreaticojejunostomy (PPJ) technique, called U-PPJ. Twenty-three patients with soft pancreas who underwent laparoscopic pancreatic surgery adopting U-PPJ method between 2017 and 2022 were enrolled (LPD = 19, LCP = 4). Preoperative, intraoperative and postoperative indexes were collected and analyzed. The results showed that all patients treated with U-PPJ were discharged without drainage tube or a small amount of exudate in the drainage tube does not require clinical treatment, but only needs to be removed after 2 days of observation. The average operation time was 417.35min. The intraoperative blood loss was 171.74ml. The pancreatic duct diameter was 3.41mm. The average postoperative hospitalization days were 11.83days. The average postoperative drainage tube removal time was 13.26days. The incidence of postoperative B-grade pancreatic fistula was 4.3%, and no C-grade pancreatic fistula occurred. In our experience, U-PPJ can be completed by a skilled surgeon in less than 20min. U-PPJ is safe, reliable, convenient and has a low incidence of CR-POPF in soft pancreas, which is worthy of clinical application. It also provides more options for laparoscopic pancreatic surgery. Since this is a retrospective study with a small number of cases, more prospective multicenter studies are needed to further verify its safety and efficacy.

Laparoscopic versus open central pancreatectomy: a propensity score-matched analysis in a single centre.

Laparoscopic central pancreatectomy (LCP) has been implemented in pancreatic surgery; however, open surgery is still the predominant approach for central pancreatectomy (CP). Our objective was to compare LCP with open CP (OCP). Data were collected from patients with tumours located in the pancreatic neck and proximal body who underwent CP in the Department of Pancreatic Surgery West China Hospital from January 1, 2010, to June 30, 2019. A comparison between the LCP and OCP groups was performed. Fifteen patients underwent CP via the laparoscopic approach, and 96 patients underwent CP via the open approach. Using 1:2 propensity score matching (PSM), 12 patients in the LCP group were matched to 21 in the OCP group. Regarding safety, postoperative pancreatic fistula (POPF) was not significantly different between the two groups (13.3% vs. 12.5%, P = 1.000), even with PSM (16.7% vs. 14.3%, P = 1.000). However, regarding effectiveness, the operative time in the OCP group was significantly shorter than that in the LCP group before (307.0 ± 92.3ml vs. 220.6 ± 63.6ml, P < 0.000) and after (300.3 ± 90.2ml vs. 212.7 ± 44.4ml, P = 0.002) PSM. Regarding length of stay (LOS), there was no difference between the two groups before (13.1 ± 13.7days vs. 12.7 ± 10.1days, P = 0.376) and after PSM (14.4 ± 15.1days vs. 14.5 ± 16.2days, P = 0.985). The length of the resected pancreas was shorter in the OCP group than in the LCP group before PSM (50.0 ± 13.2mm vs. 41.1 ± 11.1mm, P = 0.043). However, there was no difference between the two groups after PSM (47.9 ± 12.5mm vs. 37.9 ± 10.4mm, P = 0.084). Moreover, the other variables showed no difference between the two groups before and after PSM. LCP can demonstrate similar safety and effectiveness to OCP, even in the early stages of the learning curve.

Classification of Laparoscopic Central Pancreatectomy Based on Anatomical Landmarks in 100 Patients

Classification of Laparoscopic Central Pancreatectomy Based on Anatomical Landmarks in 100 Patients

Resection of the splenic vessels during laparoscopic central pancreatectomy is safe and does not compromise preservation of the distal pancreas

BackgroundThe diagnosis of low potential malignant diseases is increasingly frequent, and laparoscopic central pancreatectomy can be indicated in these patients. Laparoscopic central pancreatectomy that usually preserves the splenic vessels results in a low risk of new-onset diabetes but high morbidity, mainly due to postoperative pancreatic fistula and postpancreatectomy hemorrhage. In this study, we evaluated the short and long-term complications after laparoscopic central pancreatectomy with splenic vessel resection. MethodsThis retrospective single-center cohort study included 650 laparoscopic pancreatic resections from 2008 to 2020 with 84 laparoscopic central pancreatectomy; 15 laparoscopic central pancreatectomy with splenic vessel resection; and 69 laparoscopic central pancreatectomy with preservation of the splenic vessels. Pancreaticogastrostomy was routinely performed, and the patients were discharged after complications had been treated. The 15 laparoscopic central pancreatectomy with splenic vessel resection were matched for age, sex, body mass index, and tumor characteristics [1:2] and compared with 30 laparoscopic central pancreatectomy with the preservation of the splenic vessels. ResultsIn the laparoscopic central pancreatectomy with splenic vessel resection group, resection of splenic vessels was performed due to tumoral or inflammatory adhesions (n = 11) or accidental vascular injury (n = 4). The demographic characteristics of the groups were similar. Tumors were larger in the laparoscopic central pancreatectomy with splenic vessel resection group (40 vs 21 mm; P = .008), and right transection on the body of the pancreas (53% vs 13%; P = .01) was more frequent. There were no differences in the characteristics of the pancreas (Wirsung duct size or consistency). The median operative time (minutes) was longer in the laparoscopic central pancreatectomy with splenic vessel resection group than in the laparoscopic central pancreatectomy with preservation of the splenic vessels group (210 vs 180, respectively; P = .15) with more blood loss (100 mL vs 50 mL, respectively; P = .012). The lengths (mm) of the resected pancreas and remnant distal pancreas in the 2 groups were 65 vs 50 (P = .053) and 40 vs 65 (P = .006), respectively. There were no differences in postoperative mortality (0% vs 3%; P = .47), grade B–C postoperative pancreatic fistula (27% vs 27%; P = 1), reintervention (7% vs 13%; P = .50), grade B–C postpancreatectomy hemorrhage (0% vs 13%; P = .13), length of hospital stay (20 days vs 22 days; P = .15), or new-onset diabetes (7% vs 10%; P = .67) between the 2 groups. ConclusionLaparoscopic central pancreatectomy with splenic vessel resection is a safe technical modification of central pancreatectomy that does not prevent preservation of the distal pancreas and does not influence postoperative pancreatic fistula or endocrine insufficiency. Furthermore, it could reduce the risk of postpancreatectomy hemorrhage.

Resection of the Splenic Vessels during Laparoscopic Central Pancreatectomy Is Safe and Does Not Compromise Preservation of the Distal Pancreas

Introduction: Laparoscopic central pancreatectomy (LCP) for non-malignant tumours, usually preserving splenic vessels (LCP-PreSV), allows a low-risk of new onset diabetes and high morbidity represented mainly by postoperative pancreatic fistula (POPF) and post-pancreatectomy haemorrhage (PPH). In this study, we evaluated the impact of the splenic vessels resection (LCP-ResSV) on short and long-term complications. Methods: This was a retrospective single center cohort study. Of 650 laparoscopic pancreatic resections from 2008 to 2020, 84 LCP with pancreatogastric anastomosis were performed. The 15 LCP-ResSV were matched [1:2] and compared with 30 LCP-PreSV according to age, sex, BMI and tumour characteristics. Results: In the LCP-ResSV, splenic vessels resection was performed related to tumoral or inflammatory adhesions (n=11) and accidental vascular injury (n = 4). In the LCP-ResSV group, the tumour size was larger (40 vs 21 mm;p=0.008) and the right transection more frequently performed on the body (53%vs13%; p=0.01). The median operative time (min) was longer (210vs180; p=0.15) with more blood loss (100 mLvs 50 mL; p=0.012), respectively. The lengths (mm) of the resected pancreas and remnant distal pancreas were 65 vs 50 (p=0.053) and 40 vs 65 (p=0.006), respectively. There were no significant differences regarding postoperative mortality (0%vs3%), grade B-C POPF (27%vs27%), re-intervention (7%vs13%), grade B-C PPH (0%vs13%), hospital stay (20vs22 days) and new onset diabetes (7%vs10%). Conclusion: LCP-ResSV is a safe technical modification of CP that does not compromise preservation of the distal pancreas with no impact on POPF or endocrine insufficiency, compared to LCP-PresSV. Furthermore, it could reduce the risk of PPH.

Resection of the Splenic Vessels during Laparoscopic Central Pancreatectomy is Safe and Does Not Compromise Preservation of the Distal Pancreatectomy

Objective: 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 diabetes at the expense of a high morbidity represented mainly by postoperative pancreatic fistula (POPF) and haemorrhage (PPH). We evaluated the impact of the splenic vessels resection (LCP-ResSV) on short and long-term complications.

Laparoscopic pancreatectomy for benign or low-grade malignant pancreatic tumors: outcomes in a single high-volume institution

ObjectiveTo investigate the perioperative and long-term outcomes of laparoscopic pancreatectomy for benign and low-grade malignant pancreatic tumors, and further compare the outcomes between different surgical techniques.MethodsWe retrospectively collected clinical data of consecutive patients with benign or low-grade malignant pancreatic tumors underwent surgery from February 2014 to February 2019. Patients were grouped and compared according to different surgical operations they accepted.ResultsTotally 164 patients were reviewed and 83 patients underwent laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD), 41 patients underwent laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and 20 patients underwent laparoscopic central pancreatectomy (LCP) were included in this study, the rest 20 patients underwent laparoscopic enucleation were excluded. There were 53 male patients and 91 female patients. The median age of these patients was 53.0 years (IQR 39.3–63.0 years). The median BMI was 21.5 kg/m2 (IQR 19.7–24.0 kg/m2). The postoperative severe complication was 4.2% and the 90-days mortality was 0. Compare with LCP group, the LPPPD and LSPDP group had longer operation time (300.4 ± 89.7 vs. 197.5 ± 30.5 min, P < 0.001) while LSPDP group had shorter operation time (174.8 ± 46.4 vs. 197.5 ± 30.5 min, P = 0.027), more blood loss [140.0 (50.0–1000.0) vs. 50.0 (20.0–200.0) ml P < 0.001 and 100.0 (20.0–300.0) vs. 50.0 (20.0–200.0 ml, P = 0.039, respectively), lower rate of clinically relevant postoperative pancreatic fistula [3 (3.6%) vs. 8 (40.0%), P < 0.001 and 3 (7.3%) vs. 8 (40.0%), P = 0.006, respectively], lower rate of postpancreatectomy hemorrhage [0 (0%) vs. 2 (10.0%), P = 0.036 and (0%) vs. 2 (10.0%) P = 0.104, respectively] and lower rate of postoperative severe complications [2 (2.4%) vs.4 (20.0%), P = 0.012 and 0 (0%) vs. 4 (20.0%), P = 0.009, respectively], higher proportion of postoperative pancreatin and insulin treatment (pancreatin: 39.8% vs., 15% P = 0.037 and 24.4%vs. 15%, P = 0.390; insulin: 0 vs. 18.1%, P = 0.040 and 0 vs. 12.2%, P = 0.041).ConclusionsOverall, laparoscopic pancreatectomy could be safely performed for benign and low-grade malignant pancreatic tumors while the decision to perform laparoscopic central pancreatectomy should be made carefully for fit patients who can sustain a significant postoperative morbidity and could benefit from the excellent long-term results even in a high-volume center.

Laparoscopic versus open central pancreatectomy: A propensity score-matched analysis in a single center

Laparoscopic versus open central pancreatectomy: A propensity score-matched analysis in a single center

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.

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.

Laparoscopic central pancreatectomy: Results in 81 patients

Presenter: Safi Dokmak | Beaujon Hospital Background: Low potential malignant diseases are more frequently discovered and when surgery is indicated, parenchymal sparing resection is recommended to avoid long term endocrine and exocrine insufficiency. For centrally located lesions, central pancreatectomy (CP) can be indicated; however this one is not frequently performed related to higher morbidity compared to distal pancreatectomy. When CP is indicated, the laparoscopic approach is a good indication as the technical applicability rate is very high related to the absence of oncological or vascular contraindication. The aim of this study was to analyze our monocentric experience. Methods: Between 2008-2018, 540 laparoscopic pancreatic resections were performed in our department and 81 patients underwent laparoscopic CP. CP was indicated if enucleation was not feasible, in non-diabetic patients and if the distal pancreas was > 5 cm. The laparoscopic approach compared to the open approach was applied according to the surgeon experience and was nearly 100% with laparoscopic surgeons. The pancreas was divided on the neck by stapler when possible, the distal pancreas was mobilized and sectioned 1 cm to the left of the tumor with frozen section when indicated. One layer Pancreato-gastric anastomosis was fashioned and the nasogastric tube was left for 5 days with parenteral nutrition. All patients with pancreatic fistula were managed in the hospital until complete healing. All clinical, operative and postoperative data were recorded prospectively and were analyzed. Results: The mean age was 50 (17-77), including 55 female (68%), with a mean BMI at 25 (16-36) and 17 (21%) were obese. Indications for resection were for neuroendocrine tumor (24; 30%), IPMN (16; 20%), solid pseudopapillary tumor (12; 15%), mucinous cystadenoma (11; 14%), pancreatitis with disconnected duct syndrome (5; 6%), adenocarcinoma (3; 4%) and other (10; 11%). In patients with adenocarcinoma, the diagnosis was made postoperatively and completion distal pancreatectomy was done few weeks later. The mean operative time was 183 (90-285), the mean blood loss 107 (0-800), one transfusion (1%), and one conversion (1%) in the early experience. The pancreas was hard in 37 patients (46%). No 90 days mortality and the overall morbidity was observed in 58 patients (72%) including grade B/C pancreatic fistula (21; 26%), bleeding (10; 12%) which was severe in 5 (6%), drained collection (2; 3%), delayed gastric emptying (2; 3%), re-intervention (5; 6%), and pulmonary complications (3; 4%). the mean hospital stay was 22 days (5-54) with readmission in 2 (2%). The mean number of harvested lymph nodes was 3 (0-19) including 18 (22%) patients with zero harvested lymph nodes. Lymph nodes were only invaded in patients who turned to have adenocarcinoma. Resection was R0 in 71 (88%) patients. Conclusion: The applicability of laparoscopic central pancreatectomy is high and the morbidity is acceptable. There is a real advantage on the preservation of the pancreatic function and abdominal wall in these young patients with no malignancy.

Laparoscopic spleen-preserving distal versus central pancreatectomy for tumors in the pancreatic neck and proximal body.

For benign and borderline tumors in the pancreatic neck and proximal body, laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and laparoscopic central pancreatectomy (LCP) are alternative surgical procedures. Choosing between LSPDP and LCP is difficult. This retrospective cohort study was looking forward to provide evidence for clinical decision.A total of 59 patients undergoing LSPDP (Kimura procedure) and LCP between June 2013 and March 2017 were selected. The clinical outcomes of patients were compared by χ2 test or Fisher exact test and Student t test.This study included 36 patients in LSPDP group, and 23 patients in LCP group. The overall complications incidence in LCP group was significantly higher than LSPDP group (35 vs 6%, P = .004), and the postoperative pancreatic fistula (POPF) (grade B and C) rate and abdominal infection rate in LCP group were still significantly higher than LSPDP group (POPF 22 vs 3%, P = .019; abdominal infection 35 vs 3%, P = .001, respectively). The length of resected pancreas was significantly longer in LSPDP group (9.8 ± 2.0 vs 5.3 ± 1.1 cm, P = .007). The median follow-up was 39 months (range 12–57 months). No patient was confronted by tumor recurrence. The proportion of postoperative pancreatin and insulin treatment in LCP group were similar to LSPDP group (9 vs 17%, P = .383; 0 vs 3%, P = 1.000, respectively).For patients with poor general condition, the safety of LCP needs to be taken seriously; in some ways, LSPDP may be more secure, physiological, and easier operation for tumor located in pancreatic neck and proximal body.

Laparoscopic central pancreatectomy under clampage of the portomesenteric vein and resection of splenic vessels for large solid and cystic pseudopapillary tumor

Summary Background: Solid and cystic pseudopapillary tumor (SCPP) is frequently encountered in young females and pancreatectomy without tumor rupture is the standard of treatment. The laparoscopic approach is very indicated as patients are young and the risk of lymph nodes invasion or true vascular invasion is slow. Patients and methods: We present the case of a 24 year old female patient in whom a large SCPP was discovered on abdominal pain. The tumor of 6 cm was located on the neck-body junction with close contact with the anterior aspect of the mesentericoportal vein (MPV) and the splenic vessels. To avoid pancreatoduodenectomy or distal pancreatectomy, we decided to do laparoscopic central pancreatectomy with resection of the splenic vessels and reconstruction of the MPV if needed. She underwent central pancreatectomy with resection of the splenic vessels and the MPV was liberated from the tumor under clampage for 10 minutes without the need for reconstruction. Results: The operative duration was 260 minutes with 200 ml of blood loss. The postoperative course was uneventful with 16 days of hospital stay. Histology confirmed the diagnosis of SCPP tumor of 6 cm, R0 and N0. One year after, the patient is completely asymptomatic with no tumor recurrence and no pancreatic insufficiency. Conclusion: SCPP tumor is a good indication to the laparoscopic approach because encountered in young patients with low risk of lymph nodes or true vascular invasion. Even for large tumors, limited pancreatic resection like central pancreatectomy is possible to avoid large pancreatectomy in these young patients.

Robotic central pancreatectomy and pancreatogastrostomy: surgical technique and review of literature

Improved imaging techniques, coupled with more frequent cross-sectional imaging, have led to a recent rise in the detection of low-grade pancreatic lesions, including intraductal papillary mucinous neoplasms (IPMN), mucinous cystic neoplasms (MCN), pancreatic neuroendocrine tumors (PNET) and solid pseudopapillary tumors (SPEN). Consequently, in addition to more routine procedures to treat resectable pancreatic lesions such as the pancreaticoduodenectomy (PD) and distal pancreatectomy (DP), the use of central pancreatectomy (CP) to resect low-grade, mid-pancreatic tumors has increased. The aim of a CP is the removal of disease while maintaining optimal preservation of the surrounding pancreatic parenchyma. It has been demonstrated that open CP is safe and efficacious, but literature on robotic CP is limited. The aim of this manuscript was to describe the technique of robotic CP and review the current literature. PubMed, Embase and Google Scholar were reviewed to identify literature on robotic CP. Twelve articles reporting 116 patients were identified and data were collected. The overall morbidity and mortality was 64.7%, and 0.0% respectively. Reoperation was required in 1.7% patients, and 56.9%, and 0.9% developed postoperative pancreatic fistula (POPF) and diabetes mellitus (DM) respectively. No postoperative exocrine insufficiency. These outcomes were comparable to those reported for open and laparoscopic CP. Robotic CP is a safe procedure when performed by trained surgeons at high-volume centers.

Laparoscopic central pancreatectomy: two case reports and literature review

Laparoscopic central pancreatectomy: two case reports and literature review