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distal pancreatectomy with or without radical approach, vascular resections and splenectomy: Easier does not always mean easy

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World Journal of Gastrointestinal Surgery 2023年第6期15卷 1020-1032页

作者： Lapo Bencini Alessio Minuzzo Oncology and Robotic Surgery Careggi Main Regional and University HospitalFlorence 50131Italy

Because distal pancreatectomy(DP)has no reconstructive steps and less frequent vascular involvement,it is thought to be the easier counterpart of pancreaticoduodenectomy.This procedure has a high surgical risk and the overall incidences of perioperative morbidity(mainly pancreatic fistula),and mortality are still high,in addition to the challenges that accompany delayed access to adjuvant therapies(if any)and prolonged impairment of daily activities.Moreover,surgery to remove malignancy of the body or tail of the pancreas is associated with poor long-term oncological outcomes.From this perspective,new surgical approaches,and aggressive techniques,such as radical antegrade modular pancreato-splenectomy and DP with celiac axis resection,could lead to improved survival in those affected by more locally advanced tumors.Conversely,minimally invasive approaches such as laparoscopic and robotic surgeries and the avoidance of routine concomitant splenectomy have been developed to reduce the burden of surgical stress.The purpose of ongoing surgical research has been to achieve significant reductions in perioperative complications,length of hospital stays and the time between surgery and the beginning of adjuvant chemotherapy.Because a dedicated multidisciplinary team is crucial to pancreatic surgery,hospital and surgeon volumes have been confirmed to be associated with better outcomes in patients affected by benign,borderline,and malignant diseases of the pancreas.The purpose of this review is to examine the state of the art in distal pancreatectomies,with a special focus on minimally invasive approaches and oncological-directed techniques.The widespread reproducibility,cost-effectiveness and long-term results of each oncological procedure are also taken into deep consideration.

关键词： distal pancreatectomy Minimally invasive Splenectomy Laparoscopic

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Values of spleen-preserving distal pancreatectomy in well-differentiated non-functioning pancreatic neuroendocrine tumors:a comparative study

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Gastroenterology Report 2022年第1期10卷 513-518页

作者： Xi-Tai Huang Jin-Zhao Xie Jian-Peng Cai Peng Fang Chen-Song Huang Wei Chen Li-Jian Liang Xiao-Yu Yin Department of Pancreato-Biliary Surgery The First Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdongP.R.China

Background The feasibility of spleen-preserving distal pancreatectomy(SPDP)to treat well-differentiated non-functioning pancreatic neuroendocrine tumors(NF-pNETs)located at the body and/or tail of the pancreas remains controversial.distal pancreatectomy with splenectomy(DPS)has been widely applied in the treatment of NF-pNETs;however,it may increase the post-operative morbidities.This study aimed to evaluate whether SPDP is inferior to DPS in post-operative outcomes and survivals when being used to treat patients with NF-pNETs in our institute.Methods Clinicopathological features of patients with NF-pNETs who underwent curative SPDP or DPS at the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between January 2010 and January 2022 were collected.Short-term outcomes and 5-year survivals were compared between patients undergoing SPDP and those undergoing DPS.Results Sixty-three patients(SPDP,27;DPS,36)with well-differentiated NF-pNETs were enrolled.All patients had grade 1/2 tumors.After identifying patients with T1–T2 NF-pNETs(SPDP,27;DPS,15),there was no disparity between the SPDP and DPS groups except for tumor size(median,1.4 vs 2.6 cm,P=0.001).There were no differences in operation time(median,250 vs 295 min,P=0.478),intraoperative blood loss(median,50 vs 100 mL,P=0.145),post-operative major complications(3.7%vs 13.3%,P=0.287),clinically relevant post-operative pancreatic fistula(22.2%vs 6.7%,P=0.390),or post-operative hospital stays(median,9 vs 9 days,P=0.750)between the SPDP and DPS groups.Kaplan–Meier curve showed no significant differences in the 5-year overall survival rate(100%vs 100%,log-rank P>0.999)or recurrence-free survival(100%vs 100%,log-rank P>0.999)between patients with T1–T2 NF-pNETs undergoing SPDP and those undergoing DPS.Conclusions In patients with T1–T2 well-differentiated NF-pNETs,SPDP could achieve comparable post-operative outcomes and prognosis compared with DPS.

关键词： pancreatic neuroendocrine tumor distal pancreatectomy spleen preservation prognosis

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The learning curve for robot-assisted distal pancreatectomy: a single-center experience of 301 cases

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胰腺病学杂志(英文) 2022年第3期05卷 118-124页

作者： Xu Qiang Liu Tiantong Zou Xi Li Pengyu Gao Ruichen Dai Menghua Guo Junchao Zhang Taiping Liao Quan Liu Ziwen Wang Weibin Cong Lin Wu Wenming Zhao Yupei Department of General Surgery Peking Union Medical College Hospital 3. Beijing 4. China Chinese Academy of Medical Sciences and Peking Union Medical College State Key Laboratory of Complex Severe and Rare Diseases

Objective: Robotic distal pancreatectomy (RDP) has become a routine procedure in many pancreatic centers. This study aimed to describe a single-center experience with RDP since the first case, identify the learning curves of operation time and complication rate, and discuss the safety and feasibility of RDP.Methods: We collected and retrospectively analyzed the single-center surgical experience of 301 patients undergoing RDP at Peking Union Medical College Hospital (PUMCH) between 2012 and 2022 and described the change in operation proficiency and occurrence of perioperative complications in this observational study. The learning curve was assessed using the cumulative sum method.Results: We observed a three-phase pattern of RDP learning with operation time, complications, and postoperative pancreatic fistula as indicators and a two-phase pattern for spleening-preserving success. The mean operation time was 3.9 hours. The incidence rate of clinically significant postoperative pancreatic fistula (CRPOPF) was 17.9% and overall Clavien-Dindo complication rate (≥3) was 16.6%. The change of postoperative complicate rate was correlated with percentage of malignant cases.Conclusion: In the last decade, an evident decrease was seen in operation time, complication rate, and an increase in the spleen-preserving rate of distal pancreatectomy. With proper training, RDP is a safe and feasible procedure.

关键词： Cumulative summation distal pancreatectomy Learning curve Robot surgery Spleen-preserving

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Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy： a comparative study for short-term outcomes

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Frontiers of Medicine 2015年第3期9卷 356-360页

作者： Eric C. H. Lai Chung Ngai Tang Department of Surgery Pamela Youde Nethersole Eastern Hospital Chai Wan Hong Kong SAR China

Robotic system has been increasingly used in pancreatectomy. However, the effectiveness of this method remains uncertain. This study compared the surgical outcomes between robot-assisted laparoscopic distal pancreatectomy and conventional laparoscopic distal pancreatectomy. During a 15-year period, 35 patients underwent minimally invasive approach of distal pancreatectomy in our center. Seventeen of these patients had robot-assisted laparoscopic approach, and the remaining 18 had conventional laparoscopic approach. Their operative parameters and perioperative outcomes were analyzed retrospectively in a prospective database. The mean operating time in the robotic group （221.4 min） was significantly longer than that in the laparoscopic group （173.6 min）（P = 0.026）. Both robotic and conventional laparoscopic groups presented no significant difference in spleen-preservation rate （52.9% vs. 38.9%）（P = 0.505）, operative blood loss （100.3 ml vs. 268.3 ml）（P = 0.29）, overall morbidity rate （47.1% vs. 38.9%）（P = 0.73）, and post-operative hospital stay （11.4 days vs. 14.2 days）（P = 0.46）. Both groups also showed no perioperative mortality. Similar outcomes were observed in robotic distal pancreatectomy and conventional laparoscopic approach. However, robotic approach tended to have the advantages of less blood loss and shorter hospital stay. Further studies are necessary to determine the clinical position of robotic distal pancreatectomy.

关键词： distal pancreatectomy pancreatic neoplasm robotic surgery

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Ligamentum teres hepatis patch enhances the healing of pancreatic fistula after distal pancreatectomy

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Hepatobiliary & Pancreatic Diseases International 2013年第6期12卷 651-655页

作者： Chun-Tao Wu Wen-Yan Xu Liang Liu Jiang Long Jin Xu Quan-Xing Ni Chen Liu Xian-Jun Yu Pancreatic Cancer Institute Fudan University Department of Pancreatic and Hepatobiliary Surgery Fudan University Shanghai Cancer Center Department of Oncology Shanghai Medical CollegeFudan University

Pancreatic fistula is one of the most common complications after the distal pancreatectomy.Many methods have been tried to solve the problem,but no one is optimal,especially for the soft pancreatic stump cases.This study used ligamentum teres hepatis as a patch to cover the pancreatic stump.Between October 2010 and December 2012,seventyseven patients who had undergone distal pancreatectomy with a soft pancreatic stump were divided into two groups:group A(n=39,patients received conventional ligated main pancreatic duct method)and group B(n=38,patients underwent a coverage procedure).Patients in group A had a longer recovery from postoperative pancreatic fistula than those in group B(16.4±3.5 vs 10.8±1.6 days,Pdistal pancreatectomy.

关键词： distal pancreatectomy pancreatic fistula complications

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Spleen-preserving distal pancreatectomy with conservation of the spleen vessels

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Chinese Medical Journal 2011年第8期124卷 1217-1220页

作者： MA Jin-ping CHEN Chuang-qi PENG Lin ZHAO Gang CAI Shi-rong HU Shi-xiong HE Yu-long ZHAN Wen-hua Department of Gastrointestinal and Pancreatic Surgery the FirstAffiliated Hospital Sun Yat-sen University GuangzhouGuangdong 510080 China Department of General Surgery Guangdong General HospitalGuangzhou Guangdong 510080 China

Background distal pancreatectomy traditionally included splenectomy; the spleen, however, is an important organ in the immunologic defense of the host and is worthy of preservation. The aim of this research was to study the feasibility,safety and clinical effects of spleen and splenic vessel-preserving distal pancreatectomy.Methods A retrospective review was performed for 26 patients undergoing distal pancreatectomy for benign or low grade malignant disease with splenectomy （n=13） or splenic preservation （n=13） at the First Hospital of Sun Yat-sen University and Guangdong General Hospital in Southern China from May 2002 to April 2009.Results All 26 pancreatectomies with splenectomy or splenic preservation were performed successfully. There was no statistically significant difference between two groups in mean operative time （（172±47） minutes vs. （157±52） minutes, P ＞0.05）, intraoperative estimated blood loss （（183±68） ml vs. （160±51） ml, P ＞0.05）, incidence of noninfectious and infection complication and mean length of postoperative hospital stay （（10.1±2.2） days vs. （12.1 ±4.6） days, P ＞0.05）. The platelet counts examined one week after operation were significantly higher in the distal pancreatectomy with splenectomy group than the other group （（37.3±12.8）×109/L vs. （54.7±13.2）×109/L, P ＜0.05）.Conclusions Spleen-preserving distal pancreatectomy appears to be a feasible and safe procedure. In selected cases of benign or low-grade malignant disease, spleen-preserving distal pancreatectomy is recommended.

关键词： distal pancreatectomy spleen spleen-preserving distal pancreatectomy

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Application of retrograde distal pancreatectomy

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Hepatobiliary & Pancreatic Diseases International 2008年第3期7卷 318-321页

作者： Yang, Ye Ge, Chun-Lin Guo, Ke-Jian Guo, Ren-Xuan Tian, Yu-Lin China Med Univ Dept Gen Surg Affiliated Hosp 1 Shenyang 110001 Peoples R China

BACKGROUND: Since conventional methods are difficult to deal with pancreatic tumors close to the portal veins, we investigated the feasibility and norms for retrograde distal pancreatectomy by cutting the neck of the pancreas first. METHOD: The clinical data and surgical procedures of retrograde distal pancreatectomy given to 11 patients from July 2001 to June 2007 were analyzed. RESULTS: All 11 operations were completed successfully. The mean time of the operation was 143 71 minutes. The mean volume of hemorrhage was 239 ml. The mean time of hospitalization was 12 +/- 4.2 days. No blood transfusion was needed during the operation, and all patients had a good postoperative recovery. No neopathy of diabetes mellitus, pancreatic fistula or other complications occurred after the operation. The follow-up of all patients (4-60 months) showed that 3 patients survived for 14, 16 and 33 months, respectively, and the other patients are still alive. CONCLUSIONS: Retrograde distal pancreatectomy is useful for exposing the portal and superior mesenteric veins while avoiding operative injury. Interception of the blood supply of the spleen helps to reduce the volume of hemorrhage, while making the operation easier and the operative time short. It is advantageous for tumor resection of the body of the pancreas near the portal veins.

关键词： pancreatic neoplasm retrograde distal pancreatectomy

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Which method of distal pancreatectomy is cost-effective among open,laparoscopic,or robotic surgery?

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Hepatobiliary Surgery and Nutrition 2018年第5期7卷 345-352页

作者： Maylis Rodriguez Riccardo Memeo Piera Leon Fabrizio Panaro Stylianos Tzedakis Ornella Perotto Sharmini Varatharajah Nicola de’Angelis Pietro Riva Didier Mutter Francis Navarro Jacques Marescaux Patrick Pessaux General Digestiveand Endocrine SurgeryNouvel Hopital CivilStrasbourgFrance Institut de Recherche Contre les Cancers de l’Appareil Digestif(IRCAD)/Research Institute against Digestive Cancer StrasbourgFrance Institut Hospitalo-Universitaire(IHU) Institute for Minimally Invasive Hybrid Image-Guided SurgeryUniversite de StrasbourgStrasbourgFrance Department of Digestive Surgery Hopital Saint-EloiMontpellierFrance

Background: The aim of this study was to analyze the clinical and economic impact of robotic distal pancreatectomy, laparoscopic distal pancreatectomy, and open distal pancreatectomy. Methods: All consecutive patients who underwent distal pancreatic resection for benign and malignant diseases between January 2012 and December 2015 were prospectively included. Cost analysis was performed;all charges from patient admission to discharge were considered. Results: There were 21 robotic (RDP), 25 laparoscopic (LDP), and 43 open (ODP) procedures. Operative time was longer in the RDP group (RDP =345 minutes, LDP =306 min, ODP =251 min, P=0.01). Blood loss was higher in the ODP group (RDP =192 mL, LDP =356 mL, ODP =573 mL, P=0.0002). Spleen preservation was more frequent in the RDP group (RDP =66.6%, LDP =61.9%, ODP =9.3%, P=0.001). The rate of patients with Clavien-Dindo > grade III was higher in the ODP group (RDP =0%, LDP =12%, ODP =23%, P=0.01), especially for non-surgical complications, which were more frequent in the ODP group (RDP =9.5%, LDP =24%, ODP =41.8%, P=0.02). Length of hospital stay was increased in the ODP group (ODP =19 days, LDP =13 days, RDP =11 days, P=0.007). The total cost of the procedure, including the surgical procedure and postoperative course was higher in the ODP group (ODP =30,929 Euros, LDP=22,150 Euros, RDP =21,219 Euros, P=0.02). Conclusions: Cost-effective results of RDP seem to be similar to LDP with some better short-term outcomes.

关键词： Robotic distal pancreatectomy cost-effective laparoscopic

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New approach in laparoscopic distal pancreatectomy with preservation of splenic vessels

New approach in laparoscopic distal pancreatectomy with pres...

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2015年浙江省外科学学术年会暨国家级肝胆胰疾病诊治进...

作者： Jie Liu Cheng-Wu Zhang De-Fei Hong Jia Wu Wei-Ding Wu Zhi-Ming Hu Da-Jian Zhao Yu-Hua Zhang Department of Hepatopancreatobiliary surgery and Minimally invasive surgery Zhejiang Provincial People’s Hospital

AIM:To report our initial experience with a new approach to laparoscopic splenic vessel-preserving distal pancreatectomy(LSVPDP) in selective patients.METHODS:Fifteen patients who had undergone LSVPDP with the left anterior pararenal space(LAPS)approach in our hospital from June 2008 to May 2013 after providing informed consent for operative management were retrospectively reviewed.The surgical techniques about LAPS approach were described in detail and patient outcomes were examined.A systematic review of the literature about traditional approach to LSVPDP which 15 articles included finally were performed using the Medline,EMBASE,and PubMed databases to identify all studies published from January 2002 to December 2013.The clinical outcomes that were analyzed and compared between the two groups(LAPS-LSVPDP and LSVPDP with traditional approach) included patient age,body mass index,operative time,estimated blood loss volume,postoperative hospital stay,morbidity rate,postoperative pancreatic fistula rate,and characteristics of the resected tumors.RESULTS:All 15 operations were completed successfully by LAPS-LSVPDP,with an average operative time of 149.70 ± 46.51 minutes,blood loss of 155.70 ± 111.82 ml,and hospitalization duration of 6.80 ± 2.14 days.No intraoperative blood transfusions or excessive complications occurred with the exception of two small pancreatic fistulas and two mild infections.The final pathologic diagnosis including neuroendocrine tumors(n =1),cystic serous(n= 2) and mucinous(n = 4)neoplasms,intraductal papillary mucinous neoplasm(IPMN)(n = 1),solid pseudopapillary neoplasm(n=3),epidermoid cyst(n=l),pancreatic pseudocyst(n=2),accessory spleen(n=l).No significant differences in age,body mass index,tumor size,or complications were noted between the two groups.The LAPS approach group exhibited a significantly lower average intraoperative blood loss volume(155.7 vs 247.8 ml,P = 0.006),significantly shorter mean operative time(149.7 vs 230.8 min,P < 0.001),and significantly shorter mean hospital stay

关键词： Laparoscopic distal pancreatectomy Operative techniques Operative approach Preservation of the splenic vessels

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Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions

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Frontiers of Medicine 2020年第3期14卷 251-261页

作者： Li Jiang Deng Ning Xiao-ping Chen Department of Biliary and Pancreatic Surgery Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China Hepatic Surgery Center Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China

Postoperative pancreatic fistula (POPF) is the most common and critical complication after pancreatic body and tail resection.How to effectively reduce the occurrence of pancreatic fistula and conduct timely treatment thereafter is an urgent clinical issue to be solved.Recent research standardized the definition of pancreatic fistula and stressed the correlation between POPF classification and patient prognosis.According to the literature,identification of the risk factors for pancreatic fistula contributed to lowering the rate of the complication.Appropriate management of the pancreatic stump and perioperative treatment are of great significance to reduce the rate of POPF in clinical practice.After the occurrence of POPF,the treatment of choice should be determined according to the classification of the pancreatic fistula.However,despite the progress and promising treatment approaches,POPF remains to be a clinical issue that warrants further studies in the future.

关键词： pancreatic fistula pancreatic body and tail resection distal pancreatectomy

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