Pancreatic Body Resection Research Articles

Endovascular treatment of delayed arterial bleeding after pancreatic surgery: single-center experience

To evaluate technical aspects and clinical results of transcatheter arterial embolization (TAE) for delayed postoperative arterial bleeding after pancreatic surgery. There were 821 pancreatectomies between 2012 and 2020. Delayed bleeding occurred in 106 (12.9%) patients; 74 patients were included in the study. Previous pancreatic head resection was carried out in 75.7% of cases, pancreatic body resection - in 17.6% of cases, pancreatic tail resection - in 6.8% of patients. Primary endpoint was technical success of TAE, secondary endpoints - complications after TAE, as well as recurrent bleeding after embolization. Angiography of celiac-mesenteric arterial system was performed in 74 patients (91 procedures). The most common sources of bleeding were gastroduodenal and superior mesenteric arteries (35.7%), jejunal arteries (13.1%), common hepatic artery (11.9%). Combination of embolization agents was applied for TAE (metal coils and non-calibrated PVA particles, 48.6%). In 11 (14.9%) patients, we applied stent-grafts. Technical success rate was 100%. Recurrent bleeding occurred in 13 (17.6%) patients. In-hospital mortality was 12.2% (n=9). TAE is an effective treatment procedure in patients with arrosive bleeding. This method is characterized by high technical efficiency and low in-hospital mortality, but it does not affect recurrence of bleeding.

Total Duodenopancreatectomy Can Be Avoided in Cases of Premalignant and Benign Tumors. Single-center Retrospective Study

Introduction: The total duodenopancreatectomy (tDP) remains one of the complex and difficult for patient procedure in abdominal surgery. The indications for tDP are still controversial. There is no universal position when this surgery should be performed. Material and methods: There were 948 patients surgically treated in our department between 2011 and 2020 due to the tumors of the pancreas and periampullary zone. TDP was performed in 21 cases. Locally advanced ductal adenocarcinoma was diagnosed in 11 patients, acinar cell carcinoma — in 1 patient, multiple neuroendocrine tumors — in 5 cases, intraductal papillary mucinous neoplasms — in 3 patients, multiple metastases of renal cell carcinoma —in 1 patient. This procedure was avoided in 9 patients who underwent alternative surgeries: pancreaticoduodenectomy with pancreatic body resection, two-stage distal pancreatectomy and pancreaticoduodenectomy, simultaneous pancreatic head resection and distal pancreatectomy. Results: Postoperative complications occurred in 14 patients after tDP (77.8%) and in 5 patients after alternative surgeries (55.5%). Alternative procedures in patients with neuroendocrine tumors, intraductal papillary mucinous tumors and metastases of renal cell carcinoma ensured radical surgical treatment. The insulin or enzyme insufficiency didn’t occur in alternative cases. Conclusion: The total duodenopancreatectomy remains the surgery with the high morbidity rate and the postoperative enzyme and insulin insufficiency. TPD could be avoided in cases of benign and premalignant lesions. Alternative surgeries should be performed in such cases. The choice of the volume of surgery has to be done individually in each case and in accordance with the oncological principles. Doctors always have to estimate the benefit and the harm of the surgery.