Pancreatectomy Dotaz Zobrazit nápovědu
INTRODUCTION: Minimally invasive distal pancreatectomy (MIDP) includes both laparoscopic and robotic distal pancreatectomy (RDP). MIDP is often adopted first due to the absence of the requirement of a complex reconstruction. In recent years, an increase in the use of robotic surgery has been noted. METHODS: The authors present initial experience with RDP and retrospective analysis of data from prospectively collected database. RESULTS: Between September 2021 and October 2022 five patients undergoing RDP with splenectomy performed in the 3rd Department of Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital were included from a prospectively maintained database. The age was from 20 to 70 years. No conversion was required. One patient underwent reoperation due to staple-line hemorrhage. Postoperative hospital stay was from 4 to 14 days. The follow-up period was from 2 to 14 months. CONCLUSION: Our first experience demonstrates RDP is a safe and efficacious approach for tumors of pancreatic body and tail in selected patients. A larger number of patients is needed to obtain more accurate results.
- Klíčová slova
- MIDP, RDP, minimally invasive distal pancreatectomy, robotic distal pancreatectomy,
- MeSH
- délka pobytu MeSH
- dospělí MeSH
- laparoskopie * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- nádory slinivky břišní * chirurgie MeSH
- pankreatektomie metody MeSH
- retrospektivní studie MeSH
- roboticky asistované výkony * metody MeSH
- senioři MeSH
- splenektomie metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: Portomesenteric vein resections are a well-established part of pancreatectomies for advanced tumors that invade the portomesenteric axis. There are two main types of portomesenteric resections: partial resections, where only part of the venous wall is removed and segmental resection, where the full circumference of the wall is removed. The aim of this study is to compare short-term and long-term outcomes between these two techniques. METHODS: This is a single-centre retrospective study of the patients with pancreatic cancer who underwent pancreatectomy with portomesenteric vein resections between November 2009 and May 2021. RESULTS: From a total of 773 pancreatic cancer procedures, 43 (6%) patients underwent pancreatectomy with portomesenteric resections: 17 partial and 26 segmental. The overall median survival was 11 mo. For the partial portomesenteric resections, the median survival was 29 mo, and for the segmental portomesenteric resections, it was 10 mo (P = 0.019). The primary patency of the reconstructed veins after partial resection was 100% and after segmental resection was 92% (P = 0.220). Negative resection margins were achieved in 13 patients (76%) who underwent partial portomesenteric vein resection and 23 patients (88%) who underwent segmental portomesenteric vein resection. CONCLUSIONS: |Although this study is associated with worse survival, segmental resection is often the only way to safely remove pancreatic tumors with negative resection margins.
- Klíčová slova
- Oncovascular surgery, Pancreatectomy, Pancreatic cancer, Portomesenteric vein,
- MeSH
- lidé MeSH
- nádory slinivky břišní * patologie MeSH
- pankreatektomie * metody MeSH
- resekční okraje MeSH
- retrospektivní studie MeSH
- vena mesenterica chirurgie MeSH
- vena portae chirurgie patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
INTRODUCTION: With the introduction of the Da Vinci Xi robotic system, there has been an exponential development of robot-assisted surgical interventions. The benefits of robotic surgery are also successfully used in the field of pancreatic surgery. We present a case report of a 24-year-old female with solid pseudopapillary neoplasia of the pancreas operated on using this robotic system. CASE REPORT: A young female patient with symptomatic solid pseudopapillary neoplasia of the cauda of the pancreas underwent robot-assisted spleen-preserving distal pancreatectomy (the Kimura procedure). The operation was performed according to the plan with the use of the Da Vinci Xi robotic system without complications. The post-operative course was smooth with subsequent discharge on the sixth postoperative day. Further postoperative development was favorable and the patient is in good general condition six months after the operation. CONCLUSION: Robot-assisted surgical procedures also bring a number of advantages to the field of pancreatic surgery, which can be achieved safely and minimally invasively even in anatomically unfavorable terrain with the help of a robotic system. Although presenting a technically challenging method, it is a safe method in the treatment of benign and low-grade malignant pancreatic neoplasia.
- Klíčová slova
- Pancreas, distal pancreatectomy, pancreas, pancreatic neoplasm, robotic surgery,
- MeSH
- léčba šetřící orgány MeSH
- lidé MeSH
- mladý dospělý MeSH
- nádory slinivky břišní * chirurgie MeSH
- pankreatektomie * metody MeSH
- papilární karcinom * chirurgie MeSH
- roboticky asistované výkony * MeSH
- slezina MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Despite recent improvements in surgical technique, the morbidity of distal pancreatectomy remains high, with pancreatic fistula being the most significant postoperative complication. A systematic review of randomized controlled trials (RCTs) dealing with surgical techniques in distal pancreatectomy was carried out to summarize up-to-date knowledge on this topic. The Cochrane Central Registry of Controlled Trials, Embase, Web of Science, and Pubmed were searched for relevant articles published from 1990 to December 2013. Ten RCTs were identified and included in the systematic review, with a total of 1286 patients being randomized (samples ranging from 41 to 450). The reviewers were in agreement for application of the eligibility criteria for study selection. It was not possible to carry out meta-analysis of these studies because of the heterogeneity of surgical techniques and approaches, such as varying methods of pancreas transection, reinforcement of the stump with seromuscular patch or pancreaticoenteric anastomosis, sealing with fibrin sealants and pancreatic stent placement. Management of the pancreatic remnant after distal pancreatectomy is still a matter of debate. The results of this systematic review are possibly biased by methodological problems in some of the included studies. New well designed and carefully conducted RCTs must be performed to establish the optimal strategy for pancreatic remnant management after distal pancreatectomy.
Introduction: Total pancreatectomy (TPE) inevitably leads to absolute exocrine pancreatic insufficiency (EPI). No specific recommendations are available for enzyme replacement in such cases. The aim of our analysis was to explore the actual EPI replacement rates among patients following TPE after a certain period of time from the surgery. Methods: This retrospective analysis of living patients who had undergone TPE more than 2 years ago was done using a simple questionnaire to investigate the following: BMI prior to TPE, 3 months after TPE and at the time of data collection (in 2022), together with the actual number of daily bowel movements; and the replacement characteristics – the daily dose, its scheme and subjective satisfaction evaluation. Results: In total, we obtained data from 26 living patients with the history of TPE with their median follow up of 56 months (30–157). Malignant disease was confirmed in 69% patients based on histology; a benign tumor was present in the rest, although malignancy had been suspected preoperatively. Median BMI decreased from preoperative 27.4 (19.1–41.1) to 24.1 (19.8–33.7) 3 months following TPE, and median BMI value of 25.5 (21.2–34.5) was established at 30–157 months from TPE. The mean number of daily bowel movements was 2.2 (median 2, range 1–8) and the mean daily replacement dose was 182,000 units of lipase (median 175,000 u., range 0–250,000 u.) at the time of our investigation. Subjective satisfaction was reported by 85% responders and a lack of satisfaction despite maximum EPI replacement was expressed by 15% responders. Conclusion: BMI decreased shortly after TPE. In the long term, up to 80% of the patients achieved preoperative BMI values ±10% after TPE. Due to persistent steatorrhea and more frequent bowel movements despite enzyme replacement, 15% of the patients remained subjectively dissatisfied after TPE, but 85% of the patients did not perceive even more frequent bowel movements as unpleasant and were satisfied with their condition. The need of individualized enzyme replacement therapy of EPI following TPE is evident.
- Klíčová slova
- BMI, enzyme replacement, total pancreatectomy,
- MeSH
- intravenózní imunoglobuliny * MeSH
- receptor pro konečné produkty pokročilé glykace MeSH
- výměna plazmy * MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- intravenózní imunoglobuliny * MeSH
- receptor pro konečné produkty pokročilé glykace MeSH
BACKGROUND: Castleman disease is an uncommon lymphoproliferative disorder most frequently occurring in the mediastinum. Abdominal forms are less frequent, with pancreatic localization of the disease in particular being extremely rare. Only seventeen cases have been described in the world literature. METHOD: This report describes an interesting and unusual case of pancreatic Castleman disease treated with laparoscopic resection. RESULTS: A 48-year-old woman presented with epigastric pain. CT scan showed a well-encapsulated mass on the ventral border of the pancreas. Endosonography with fine needle aspiration biopsy was performed. Biopsy showed lymphoid elements and structures of a normal lymph node. The patient was treated with laparoscopic distal pancreatectomy. The pancreas was transected with a Ligasure device and the pancreatic stump was secured with a manual suture. One year after surgery the patient was complaint-free and showed no signs of recurrence of the disease. CONCLUSIONS: Laparoscopic distal pancreatectomy is a feasible and safe method for the treatment of lesions in the body and tail of the pancreas. Transection of the pancreas with a Ligasure device offers the advantages of low bleeding and low risk of pancreatic fistula.
- MeSH
- biopsie tenkou jehlou pod endosonografickou kontrolou MeSH
- hyperplazie velkých lymfatických uzlin diagnóza chirurgie MeSH
- laparoskopie * MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci slinivky břišní diagnóza chirurgie MeSH
- pankreatektomie metody MeSH
- počítačová rentgenová tomografie MeSH
- šicí techniky MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
OBJECTIVE: To assess outcomes among patients undergoing total pancreatectomy (TP) including predictors for complications and in-hospital mortality. BACKGROUND: Current studies on TP mostly originate from high-volume centers and span long time periods and therefore may not reflect daily practice. METHODS: This prospective pan-European snapshot study included patients who underwent elective (primary or completion) TP in 43 centers in 16 European countries (June 2018-June 2019). Subgroup analysis included cutoff values for annual volume of pancreatoduodenectomies (<60 vs ≥60).Predictors for major complications and in-hospital mortality were assessed in multivariable logistic regression. RESULTS: In total, 277 patients underwent TP, mostly for malignant disease (73%). Major postoperative complications occurred in 70 patients (25%). Median hospital stay was 12 days (IQR 9-18) and 40 patients were readmitted (15%). In-hospital mortality was 5% and 90-day mortality 8%. In the subgroup analysis, in-hospital mortality was lower in patients operated in centers with ≥60 pancreatoduodenectomies compared <60 (4% vs 10%, P = 0.046). In multivariable analysis, annual volume <60 pancreatoduodenectomies (OR 3.78, 95% CI 1.18-12.16, P = 0.026), age (OR 1.07, 95% CI 1.01-1.14, P = 0.046), and estimated blood loss ≥2L (OR 11.89, 95% CI 2.64-53.61, P = 0.001) were associated with in-hospital mortality. ASA ≥3 (OR 2.87, 95% CI 1.56-5.26, P = 0.001) and estimated blood loss ≥2L (OR 3.52, 95% CI 1.25-9.90, P = 0.017) were associated with major complications. CONCLUSION: This pan-European prospective snapshot study found a 5% inhospital mortality after TP. The identified predictors for mortality, including low-volume centers, age, and increased blood loss, may be used to improve outcomes.
The major postoperative complication after open and laparoscopic distal pancreatectomy is pancreatic fistula. Different operative techniques have been tested to minimize this unpleasant complication. We evaluated a new technique for pancreatic stump reinforcement with synthetic glue after laparoscopic distal pancreatectomy. Ten female domestic pigs were divided into 2 groups; in group A (n=5), the pancreas was transected using an EndoGIA stapler, whereas in group B (n=5), the pancreas was transected using a Ligasure device and the pancreatic stump was reinforced with a hydrogel sealant. The clinical postoperative course was uneventful in all the cases. No differences were observed in pancreatic remnant healing between the groups, and only minor microscopic alterations of the healing process were found in the groups. The technique using Ligasure transection reinforced by the hydrogel sealant seems to be comparable with the standard transection technique using the stapler.
- MeSH
- chirurgické staplery MeSH
- hojení ran fyziologie MeSH
- laparoskopie * MeSH
- ligace MeSH
- pankreas fyziologie chirurgie MeSH
- pankreatektomie metody MeSH
- PEG-DMA hydrogel terapeutické užití MeSH
- prasata MeSH
- zvířata MeSH
- Check Tag
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Názvy látek
- PEG-DMA hydrogel MeSH
OBJECTIVE: Pancreatic islet autotransplantation (IAT) has a potential to prevent brittle diabetes in patients after total pancreatectomy. Because of the fear of tumor spread, IAT has rarely been used in case of malignancy. We report our experience with patients who underwent hemipancreatoduodenectomy for carcinoma and later completion pancreatectomy for pancreatic fistula with islet autotransplantation at our institution. METHODS: From August 2007 to December 2012, 5 patients underwent IAT after completion pancreatectomy for pancreatic fistula after hemipancreatoduodenectomy for carcinoma. Islets were isolated from the pancreatic tail with the use of digestion with collagenase. Nonpurified islet suspension was infused into the portal vein during surgery. RESULTS: The median number of islets transplanted was 175,000 islet equivalents (range, 70,000-365,000). One patient died after surgery for reasons unrelated to IAT. Another 3 patients had stable diabetes with partial graft function (fasting C-peptide levels 0.23, 0.41, and 0.61 nmol/L and HbA1c 4.8%, 4.6%, and 6.9% at 24, 24 and 9 months after IAT, respectively). The 1st patient, with pancreatic head carcinoma, was alive 28 months after IAT with lymph node and liver recurrence since 18 months after IAT. The 2nd patient, with gall bladder and distal bile duct carcinoma, died 47 months after IAT with tumor recurrence. The 3rd patient, with ampullary carcinoma, died 12 months after IAT with local recurrence and solitary liver metastasis. The last patient had been off insulin 9 months after IAT without tumor recurrence (fasting C-peptide, 0.89 nmol/L; HbA1c, 4.2%). CONCLUSIONS: Autotransplantation of pancreatic islets isolated from the residual pancreatic tissue in patients who previously underwent hemipancreatoduodenectomy for cancer may provide stable glucose control and thus improve quality of life. In this small series we did not observe early development of multiple liver metastases caused by islet suspension contamination with malignant cells. Oncologic outcome of the patients was not worse than what would be expected without IAT.
- MeSH
- autologní transplantace MeSH
- diabetes mellitus 1. typu etiologie mortalita chirurgie MeSH
- karcinom mortalita patologie chirurgie MeSH
- kohortové studie MeSH
- lidé MeSH
- nádory slinivky břišní mortalita patologie chirurgie MeSH
- pankreatektomie škodlivé účinky MeSH
- pankreatická píštěl etiologie mortalita chirurgie MeSH
- pankreatoduodenektomie škodlivé účinky MeSH
- transplantace Langerhansových ostrůvků * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- cholin krev metabolismus MeSH
- inzulin metabolismus MeSH
- králíci MeSH
- krevní glukóza metabolismus MeSH
- krysa rodu Rattus MeSH
- mozek metabolismus MeSH
- myokard metabolismus MeSH
- pankreas fyziologie MeSH
- pankreatektomie MeSH
- vazba proteinů MeSH
- zvířata MeSH
- Check Tag
- králíci MeSH
- krysa rodu Rattus MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- cholin MeSH
- inzulin MeSH
- krevní glukóza MeSH
