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Extended distal pancreatectomy for advanced pancreatic neck cancer.

Park SY, Shin WY, Choe YM, Lee KY, Ahn SI - Korean J Hepatobiliary Pancreat Surg (2014)

Bottom Line: The results were compared with those after standard pancreatectomy.All three patients presented with jaundice, and the ratio of pancreatic duct to parenchymal thickness of the pancreatic body was greater than 0.5.Also, the procedure is technically feasible, and further refinement is necessary to improve patient survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Inha University School of Medicine, Incheon, Korea.

ABSTRACT

Backgrounds/aims: We investigated the clinical application of extended distal pancreatectomy in patients with pancreatic neck cancer accompanied by distal pancreatic atrophy. In this study, we have emphasized on the technical aspects of using the linear stapling device for a bulky target organ.

Methods: From March 2010 to September 2013, 46 patients with pancreatic adenocarcinoma, who underwent pancreatic resection with radical intent at our institute, were reviewed retrospectively. Among them, three patients (6.5%) underwent extended distal pancreatectomy. A linear stapling device and vise-grip locking pliers were used for en bloc resection of the distal pancreas, first duodenal portion, and distal common bile duct. The results were compared with those after standard pancreatectomy.

Results: All three patients presented with jaundice, and the ratio of pancreatic duct to parenchymal thickness of the pancreatic body was greater than 0.5. Grade A pancreatic fistula developed in all of the cases, but none of these fistulae were lethal. Pathological staging was T3N1M0 in all of the patients. The postoperative daily serum glucose fluctuations and insulin requirements were comparable to those in patients who received pancreaticoduodenectomy or distal pancreatectomy. At the last follow-up, two patients were alive with liver metastasis at 4 and 10 months postoperatively, respectively, and one patient died of liver metastasis at 5 months postoperatively.

Conclusions: While the prognosis of advanced pancreatic neck adenocarcinoma is still dismal, extended distal pancreatectomy is a valid treatment option, especially when there is atrophy of the distal pancreas. Also, the procedure is technically feasible, and further refinement is necessary to improve patient survival.

No MeSH data available.


Related in: MedlinePlus

Operative procedures. (A) A linear stapling device (arrow) and vise-grip locking pliers (arrowhead) are applied to resect the specimen en bloc. (B) Schematic diagram showing the resection line (dotted), along with the stapler line (solid).
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Figure 2: Operative procedures. (A) A linear stapling device (arrow) and vise-grip locking pliers (arrowhead) are applied to resect the specimen en bloc. (B) Schematic diagram showing the resection line (dotted), along with the stapler line (solid).

Mentions: A linear stapling device (PROXIMATE® TCT 10, ETHICON ENDO-SURGERY, LLC, Guaynabo, Puerto Rico, 00969, USA) with a green cartridge was used to perform en bloc resection of the distal pancreas, first duodenal portion, and distal common bile duct. When it was difficult to close the jaws of the linear stapler due to the bulk of the target organs, vise-grip locking pliers were applied to force the jaws together (Fig. 2). The resected margins of the pancreatic head, common hepatic duct, and duodenum were sent to pathology for frozen section evaluation. After the resection, the invaded portion of the portal vein or superior mesenteric vein was resected and reconstructed using an artificial graft in a separate procedure (Fig. 3A). Gastrointestinal continuity was restored by Roux-en-Y hepaticojejunostomy, gastro- or duodenojejunostomy, and jejunojejunostomy (Fig. 3B).


Extended distal pancreatectomy for advanced pancreatic neck cancer.

Park SY, Shin WY, Choe YM, Lee KY, Ahn SI - Korean J Hepatobiliary Pancreat Surg (2014)

Operative procedures. (A) A linear stapling device (arrow) and vise-grip locking pliers (arrowhead) are applied to resect the specimen en bloc. (B) Schematic diagram showing the resection line (dotted), along with the stapler line (solid).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492328&req=5

Figure 2: Operative procedures. (A) A linear stapling device (arrow) and vise-grip locking pliers (arrowhead) are applied to resect the specimen en bloc. (B) Schematic diagram showing the resection line (dotted), along with the stapler line (solid).
Mentions: A linear stapling device (PROXIMATE® TCT 10, ETHICON ENDO-SURGERY, LLC, Guaynabo, Puerto Rico, 00969, USA) with a green cartridge was used to perform en bloc resection of the distal pancreas, first duodenal portion, and distal common bile duct. When it was difficult to close the jaws of the linear stapler due to the bulk of the target organs, vise-grip locking pliers were applied to force the jaws together (Fig. 2). The resected margins of the pancreatic head, common hepatic duct, and duodenum were sent to pathology for frozen section evaluation. After the resection, the invaded portion of the portal vein or superior mesenteric vein was resected and reconstructed using an artificial graft in a separate procedure (Fig. 3A). Gastrointestinal continuity was restored by Roux-en-Y hepaticojejunostomy, gastro- or duodenojejunostomy, and jejunojejunostomy (Fig. 3B).

Bottom Line: The results were compared with those after standard pancreatectomy.All three patients presented with jaundice, and the ratio of pancreatic duct to parenchymal thickness of the pancreatic body was greater than 0.5.Also, the procedure is technically feasible, and further refinement is necessary to improve patient survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Inha University School of Medicine, Incheon, Korea.

ABSTRACT

Backgrounds/aims: We investigated the clinical application of extended distal pancreatectomy in patients with pancreatic neck cancer accompanied by distal pancreatic atrophy. In this study, we have emphasized on the technical aspects of using the linear stapling device for a bulky target organ.

Methods: From March 2010 to September 2013, 46 patients with pancreatic adenocarcinoma, who underwent pancreatic resection with radical intent at our institute, were reviewed retrospectively. Among them, three patients (6.5%) underwent extended distal pancreatectomy. A linear stapling device and vise-grip locking pliers were used for en bloc resection of the distal pancreas, first duodenal portion, and distal common bile duct. The results were compared with those after standard pancreatectomy.

Results: All three patients presented with jaundice, and the ratio of pancreatic duct to parenchymal thickness of the pancreatic body was greater than 0.5. Grade A pancreatic fistula developed in all of the cases, but none of these fistulae were lethal. Pathological staging was T3N1M0 in all of the patients. The postoperative daily serum glucose fluctuations and insulin requirements were comparable to those in patients who received pancreaticoduodenectomy or distal pancreatectomy. At the last follow-up, two patients were alive with liver metastasis at 4 and 10 months postoperatively, respectively, and one patient died of liver metastasis at 5 months postoperatively.

Conclusions: While the prognosis of advanced pancreatic neck adenocarcinoma is still dismal, extended distal pancreatectomy is a valid treatment option, especially when there is atrophy of the distal pancreas. Also, the procedure is technically feasible, and further refinement is necessary to improve patient survival.

No MeSH data available.


Related in: MedlinePlus