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Laparoscopic central pancreatectomy: Our technique and long-term results in 14 patients.

Senthilnathan P, Gul SI, Gurumurthy SS, Palanivelu PR, Parthasarathi R, Palanisamy NV, Natesan VA, Palanivelu C - J Minim Access Surg (2015 Jul-Sep)

Bottom Line: There were no mortalities and no major postoperative complications.Margins were negative in all cases and with a median follow-up of 44 months, there was no recurrence.In the long term, there were no recurrences and pancreatic function was well preserved.

View Article: PubMed Central - PubMed

Affiliation: Department of Hepato Pancreatico Biliary surgery, Gem Hospital and Research Center, Coimbatore, Tamil Nadu, India.

ABSTRACT

Introduction: Conventional pancreatic resections may be unnecessary for benign tumours or for tumours of low malignant potential located in the neck and body of pancreas. Such extensive resections can place the patient at increased risk of developing postoperative exocrine and endocrine insufficiency. Central pancreatectomy is a plausible surgical option for the management of tumours located in these locations. Laparoscopic approach seems appropriate for such small tumours situated deep in the retroperitoneum.

Aims: To assess the technical feasibility, safety and long-term results of laparoscopic central pancreatectomy in patients with benign and low malignant potential tumours involving the neck and body of pancreas.

Settings and design: This study was an observational study which reports a single-centre experience with laparoscopic central pancreatectomy over a 9-year period.

Materials and methods: 14 patients underwent laparoscopic central pancreatectomy from October 2004 to September 2013. These included patients with tumours located in the neck and body of pancreas that were radiologically benign-looking tumours of less than 3 cm in size.

Statistical analysis used: The statistical analysis was done using GraphPad Prism software.

Results: The mean age of patients was 48.93 years. The mean operative time was 239.7 min. Mean blood loss was 153.2 ml. Mean postoperative ICU stay was 1.2 days and overall mean hospital stay was 8.07 days. There were no mortalities and no major postoperative complications. Margins were negative in all cases and with a median follow-up of 44 months, there was no recurrence.

Conclusions: Laparoscopic central pancreatectomy is a feasible procedure with acceptable morbidity. In the long term, there were no recurrences and pancreatic function was well preserved.

No MeSH data available.


Related in: MedlinePlus

Completion of laparoscopic pancreaticojejunostomy
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Figure 3: Completion of laparoscopic pancreaticojejunostomy

Mentions: Pancreatic branches supplying the mobilised pancreas are divided. Endo GIA 60 mm stapler is used to divide the pancreas proximal to the tumour [Figure 1]. A blue (45 mm/60 mm) cartridge or a golden (60 mm) cartridge can be used depending upon the pancreatic parenchymal volume. Distally the pancreas is divided using ultrasonic shears and the central portion with the tumour is removed [Figure 2]. However, care is taken not to use ultrasonic shears in the area of presumed duct where scissors are used instead to cut the pancreatic parenchyma. The distal stump is mobilised for 2 cm. Distal pancreatic stump is anastomosed to Roux-en-Y limb of the jejunum intracorporeally. We use dunking as our standard anastomotic technique for soft undilated pancreatic ducts [Figure 3]. However, in two patients, a duct to mucosa anastomotic technique was applied in view of firm pancreas with a dilated pancreatic duct. A drain is placed near the site of anastomosis.


Laparoscopic central pancreatectomy: Our technique and long-term results in 14 patients.

Senthilnathan P, Gul SI, Gurumurthy SS, Palanivelu PR, Parthasarathi R, Palanisamy NV, Natesan VA, Palanivelu C - J Minim Access Surg (2015 Jul-Sep)

Completion of laparoscopic pancreaticojejunostomy
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499920&req=5

Figure 3: Completion of laparoscopic pancreaticojejunostomy
Mentions: Pancreatic branches supplying the mobilised pancreas are divided. Endo GIA 60 mm stapler is used to divide the pancreas proximal to the tumour [Figure 1]. A blue (45 mm/60 mm) cartridge or a golden (60 mm) cartridge can be used depending upon the pancreatic parenchymal volume. Distally the pancreas is divided using ultrasonic shears and the central portion with the tumour is removed [Figure 2]. However, care is taken not to use ultrasonic shears in the area of presumed duct where scissors are used instead to cut the pancreatic parenchyma. The distal stump is mobilised for 2 cm. Distal pancreatic stump is anastomosed to Roux-en-Y limb of the jejunum intracorporeally. We use dunking as our standard anastomotic technique for soft undilated pancreatic ducts [Figure 3]. However, in two patients, a duct to mucosa anastomotic technique was applied in view of firm pancreas with a dilated pancreatic duct. A drain is placed near the site of anastomosis.

Bottom Line: There were no mortalities and no major postoperative complications.Margins were negative in all cases and with a median follow-up of 44 months, there was no recurrence.In the long term, there were no recurrences and pancreatic function was well preserved.

View Article: PubMed Central - PubMed

Affiliation: Department of Hepato Pancreatico Biliary surgery, Gem Hospital and Research Center, Coimbatore, Tamil Nadu, India.

ABSTRACT

Introduction: Conventional pancreatic resections may be unnecessary for benign tumours or for tumours of low malignant potential located in the neck and body of pancreas. Such extensive resections can place the patient at increased risk of developing postoperative exocrine and endocrine insufficiency. Central pancreatectomy is a plausible surgical option for the management of tumours located in these locations. Laparoscopic approach seems appropriate for such small tumours situated deep in the retroperitoneum.

Aims: To assess the technical feasibility, safety and long-term results of laparoscopic central pancreatectomy in patients with benign and low malignant potential tumours involving the neck and body of pancreas.

Settings and design: This study was an observational study which reports a single-centre experience with laparoscopic central pancreatectomy over a 9-year period.

Materials and methods: 14 patients underwent laparoscopic central pancreatectomy from October 2004 to September 2013. These included patients with tumours located in the neck and body of pancreas that were radiologically benign-looking tumours of less than 3 cm in size.

Statistical analysis used: The statistical analysis was done using GraphPad Prism software.

Results: The mean age of patients was 48.93 years. The mean operative time was 239.7 min. Mean blood loss was 153.2 ml. Mean postoperative ICU stay was 1.2 days and overall mean hospital stay was 8.07 days. There were no mortalities and no major postoperative complications. Margins were negative in all cases and with a median follow-up of 44 months, there was no recurrence.

Conclusions: Laparoscopic central pancreatectomy is a feasible procedure with acceptable morbidity. In the long term, there were no recurrences and pancreatic function was well preserved.

No MeSH data available.


Related in: MedlinePlus