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Small amounts of tissue preserve pancreatic function

View Article: PubMed Central - PubMed

ABSTRACT

Middle-segment preserving pancreatectomy (MPP) is a novel procedure for treating multifocal lesions of the pancreas while preserving pancreatic function. However, long-term pancreatic function after this procedure remains unclear.

The aims of this current study are to investigate short- and long-term outcomes, especially long-term pancreatic endocrine function, after MPP.

From September 2011 to December 2015, 7 patients underwent MPP in our institution, and 5 cases with long-term outcomes were further analyzed in a retrospective manner. Percentage of tissue preservation was calculated using computed tomography volumetry. Serum insulin and C-peptide levels after oral glucose challenge were evaluated in 5 patients. Beta-cell secreting function including modified homeostasis model assessment of beta-cell function (HOMA2-beta), area under the curve (AUC) for C-peptide, and C-peptide index were evaluated and compared with those after pancreaticoduodenectomy (PD) and total pancreatectomy. Exocrine function was assessed based on questionnaires.

Our case series included 3 women and 2 men, with median age of 50 (37–81) years. Four patients underwent pylorus-preserving PD together with distal pancreatectomy (DP), including 1 with spleen preserved. The remaining patient underwent Beger procedure and spleen-preserving DP. Median operation time and estimated intraoperative blood loss were 330 (250–615) min and 800 (400–5500) mL, respectively. Histological examination revealed 3 cases of metastatic lesion to the pancreas, 1 case of chronic pancreatitis, and 1 neuroendocrine tumor. Major postoperative complications included 3 cases of delayed gastric emptying and 2 cases of postoperative pancreatic fistula. Imaging studies showed that segments representing 18.2% to 39.5% of the pancreas with good blood supply had been preserved. With a median 35.0 months of follow-ups on pancreatic functions, only 1 patient developed new-onset diabetes mellitus of the 4 preoperatively euglycemic patients. Beta-cell function parameters in this group of patients were quite comparable to those after Whipple procedure, and seemed better than those after total pancreatectomy. No symptoms of hypoglycemia were identified in any patient, although half of the patients reported symptoms of exocrine insufficiency.

In conclusion, MPP is a feasible and effective procedure for middle-segment sparing multicentric lesions in the pancreas, and patients exhibit satisfied endocrine function after surgery.

No MeSH data available.


Preoperative abdominal CT scans. Lesions in head and tail portion of the pancreas were shown in the picture, with arrows for head lesions and arrowheads for tail ones. For improved identification of lesions, different phases of CT scanning are shown for different lesions (plain scan for cases 1 and 5, arterial phase for cases 2–4). CT = computed tomography.
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Figure 1: Preoperative abdominal CT scans. Lesions in head and tail portion of the pancreas were shown in the picture, with arrows for head lesions and arrowheads for tail ones. For improved identification of lesions, different phases of CT scanning are shown for different lesions (plain scan for cases 1 and 5, arterial phase for cases 2–4). CT = computed tomography.

Mentions: Three of the 5 patients (Cases 2–4) had a previous history of some type of tumor, including 1 case of renal clear cell carcinoma, 1 case of dermatofibrosarcoma protuberans (DFSP) in the shoulder, and 1 case of bilateral adrenal pheochromocytoma, respectively (Table 2). All 3 patients had received curative resection for the primary lesions. Considering the above history, together with the CT findings, preoperative diagnoses of these patients were multiple pancreatic metastases from previous malignancies (Fig. 1; Table 2). The remaining 2 cases were diagnosed as chronic pancreatitis with pancreatic duct stones and a multiple neuroendocrine tumor, based on clinical manifestations, laboratory, and imaging studies (Fig. 1; Table 2). Preoperative imaging studies showed that, in all cases, both the pancreatic head and tail regions were involved, with a body segment free of disease (Fig. 1). Extrapancreatic lesions were observed in 2 cases: case 3 had a metastatic lesion in the right lung and case 4 had recurrence in a previous surgical site of left adrenalectomy.


Small amounts of tissue preserve pancreatic function
Preoperative abdominal CT scans. Lesions in head and tail portion of the pancreas were shown in the picture, with arrows for head lesions and arrowheads for tail ones. For improved identification of lesions, different phases of CT scanning are shown for different lesions (plain scan for cases 1 and 5, arterial phase for cases 2–4). CT = computed tomography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120908&req=5

Figure 1: Preoperative abdominal CT scans. Lesions in head and tail portion of the pancreas were shown in the picture, with arrows for head lesions and arrowheads for tail ones. For improved identification of lesions, different phases of CT scanning are shown for different lesions (plain scan for cases 1 and 5, arterial phase for cases 2–4). CT = computed tomography.
Mentions: Three of the 5 patients (Cases 2–4) had a previous history of some type of tumor, including 1 case of renal clear cell carcinoma, 1 case of dermatofibrosarcoma protuberans (DFSP) in the shoulder, and 1 case of bilateral adrenal pheochromocytoma, respectively (Table 2). All 3 patients had received curative resection for the primary lesions. Considering the above history, together with the CT findings, preoperative diagnoses of these patients were multiple pancreatic metastases from previous malignancies (Fig. 1; Table 2). The remaining 2 cases were diagnosed as chronic pancreatitis with pancreatic duct stones and a multiple neuroendocrine tumor, based on clinical manifestations, laboratory, and imaging studies (Fig. 1; Table 2). Preoperative imaging studies showed that, in all cases, both the pancreatic head and tail regions were involved, with a body segment free of disease (Fig. 1). Extrapancreatic lesions were observed in 2 cases: case 3 had a metastatic lesion in the right lung and case 4 had recurrence in a previous surgical site of left adrenalectomy.

View Article: PubMed Central - PubMed

ABSTRACT

Middle-segment preserving pancreatectomy (MPP) is a novel procedure for treating multifocal lesions of the pancreas while preserving pancreatic function. However, long-term pancreatic function after this procedure remains unclear.

The aims of this current study are to investigate short- and long-term outcomes, especially long-term pancreatic endocrine function, after MPP.

From September 2011 to December 2015, 7 patients underwent MPP in our institution, and 5 cases with long-term outcomes were further analyzed in a retrospective manner. Percentage of tissue preservation was calculated using computed tomography volumetry. Serum insulin and C-peptide levels after oral glucose challenge were evaluated in 5 patients. Beta-cell secreting function including modified homeostasis model assessment of beta-cell function (HOMA2-beta), area under the curve (AUC) for C-peptide, and C-peptide index were evaluated and compared with those after pancreaticoduodenectomy (PD) and total pancreatectomy. Exocrine function was assessed based on questionnaires.

Our case series included 3 women and 2 men, with median age of 50 (37–81) years. Four patients underwent pylorus-preserving PD together with distal pancreatectomy (DP), including 1 with spleen preserved. The remaining patient underwent Beger procedure and spleen-preserving DP. Median operation time and estimated intraoperative blood loss were 330 (250–615) min and 800 (400–5500) mL, respectively. Histological examination revealed 3 cases of metastatic lesion to the pancreas, 1 case of chronic pancreatitis, and 1 neuroendocrine tumor. Major postoperative complications included 3 cases of delayed gastric emptying and 2 cases of postoperative pancreatic fistula. Imaging studies showed that segments representing 18.2% to 39.5% of the pancreas with good blood supply had been preserved. With a median 35.0 months of follow-ups on pancreatic functions, only 1 patient developed new-onset diabetes mellitus of the 4 preoperatively euglycemic patients. Beta-cell function parameters in this group of patients were quite comparable to those after Whipple procedure, and seemed better than those after total pancreatectomy. No symptoms of hypoglycemia were identified in any patient, although half of the patients reported symptoms of exocrine insufficiency.

In conclusion, MPP is a feasible and effective procedure for middle-segment sparing multicentric lesions in the pancreas, and patients exhibit satisfied endocrine function after surgery.

No MeSH data available.