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Central pancreatectomy without anastomosis.

Wayne M, Neragi-Miandoab S, Kasmin F, Brown W, Pahuja A, Cooperman AM - World J Surg Oncol (2009)

Bottom Line: The surgical indications, operative outcomes, and pathologic findings were analyzed.All 10 lesions were in the neck of the pancreas and included: 2 branch intraductal papillary mucinous neoplasms (IPMNs), a mucinous cyst, a lymphoid cyst, 5 neuroendocrine tumors, and a clear cell adenoma.Long term endocrine and exocrine function has been maintained.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Pancreas and Biliary Center at Saint Vincent's Hospital, New York, NY 10011, USA. waynedocny@yahoo.com

ABSTRACT

Background: Central pancreatectomy has a unique application for lesions in the neck of the pancreas. It preserves the distal pancreas and its endocrine functions. It also preserves the spleen.

Methods: This is a retrospective review of 10 patients who underwent central pancreatectomy without pancreatico-enteric anastomosis between October 2005 and May 2009. The surgical indications, operative outcomes, and pathologic findings were analyzed.

Results: All 10 lesions were in the neck of the pancreas and included: 2 branch intraductal papillary mucinous neoplasms (IPMNs), a mucinous cyst, a lymphoid cyst, 5 neuroendocrine tumors, and a clear cell adenoma.

Conclusion: Central pancreatectomy without pancreatico-enteric anastomosis for lesions in the neck and proximal pancreas is a safe and effective procedure. Morbidity is low because there is no anastomosis. Long term endocrine and exocrine function has been maintained.

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Operative site after removal of central portion of the pancreas.
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Figure 1: Operative site after removal of central portion of the pancreas.

Mentions: Each operation was performed through an upper midline incision. The stomach is retracted downwards while the gastro-hepatic omentum is incised exposing the neck, body, and a portion of the tail of the pancreas. The gastro-colic omentum is dissected as needed. If necessary, the stomach can be retracted superiorly while the transverse colon is retracted downwards and this facilitates exposure of the lower border of the pancreas and dissection of the superior mesenteric vein (SMV) behind the pancreas. Stay sutures are placed on either side of the lesion in the superior and inferior aspect of the pancreas. This facilitates dissection from the SMV and the stay sutures also help to control the transverse pancreatic vessels as well. Once the SMV is completely dissected from the pancreas, the distal margin of pancreas is transected, while protecting the SMV. The specimen is then excised by transecting the proximal margin. (Figure 1) The lesion is then sent to pathology to be evaluated for margins by frozen section, an example is seen in figure 2. The transected pancreas is oversown after ligating both ends of the transected pancreatic duct. The pancreatic duct is suture ligated with a 4-0 vicryl suture and then the transected pancreas is oversewn with a running 4-0 prolene suture, imbricating the pancreatic capsule. A drain is placed and the abdomen is closed in standard fashion. The drains were removed upon discharge because there were no fistulas in our group.


Central pancreatectomy without anastomosis.

Wayne M, Neragi-Miandoab S, Kasmin F, Brown W, Pahuja A, Cooperman AM - World J Surg Oncol (2009)

Operative site after removal of central portion of the pancreas.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2743692&req=5

Figure 1: Operative site after removal of central portion of the pancreas.
Mentions: Each operation was performed through an upper midline incision. The stomach is retracted downwards while the gastro-hepatic omentum is incised exposing the neck, body, and a portion of the tail of the pancreas. The gastro-colic omentum is dissected as needed. If necessary, the stomach can be retracted superiorly while the transverse colon is retracted downwards and this facilitates exposure of the lower border of the pancreas and dissection of the superior mesenteric vein (SMV) behind the pancreas. Stay sutures are placed on either side of the lesion in the superior and inferior aspect of the pancreas. This facilitates dissection from the SMV and the stay sutures also help to control the transverse pancreatic vessels as well. Once the SMV is completely dissected from the pancreas, the distal margin of pancreas is transected, while protecting the SMV. The specimen is then excised by transecting the proximal margin. (Figure 1) The lesion is then sent to pathology to be evaluated for margins by frozen section, an example is seen in figure 2. The transected pancreas is oversown after ligating both ends of the transected pancreatic duct. The pancreatic duct is suture ligated with a 4-0 vicryl suture and then the transected pancreas is oversewn with a running 4-0 prolene suture, imbricating the pancreatic capsule. A drain is placed and the abdomen is closed in standard fashion. The drains were removed upon discharge because there were no fistulas in our group.

Bottom Line: The surgical indications, operative outcomes, and pathologic findings were analyzed.All 10 lesions were in the neck of the pancreas and included: 2 branch intraductal papillary mucinous neoplasms (IPMNs), a mucinous cyst, a lymphoid cyst, 5 neuroendocrine tumors, and a clear cell adenoma.Long term endocrine and exocrine function has been maintained.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Pancreas and Biliary Center at Saint Vincent's Hospital, New York, NY 10011, USA. waynedocny@yahoo.com

ABSTRACT

Background: Central pancreatectomy has a unique application for lesions in the neck of the pancreas. It preserves the distal pancreas and its endocrine functions. It also preserves the spleen.

Methods: This is a retrospective review of 10 patients who underwent central pancreatectomy without pancreatico-enteric anastomosis between October 2005 and May 2009. The surgical indications, operative outcomes, and pathologic findings were analyzed.

Results: All 10 lesions were in the neck of the pancreas and included: 2 branch intraductal papillary mucinous neoplasms (IPMNs), a mucinous cyst, a lymphoid cyst, 5 neuroendocrine tumors, and a clear cell adenoma.

Conclusion: Central pancreatectomy without pancreatico-enteric anastomosis for lesions in the neck and proximal pancreas is a safe and effective procedure. Morbidity is low because there is no anastomosis. Long term endocrine and exocrine function has been maintained.

Show MeSH
Related in: MedlinePlus