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PubMed1994

[A canine model of pancreas transplantation recipient following total pancreatectomy and associated lymphoproliferation].

An attempt was made to use a diabetic dog as a model recipient of pancreas transplantation. The diabetic state was induced by total pancreatectomy, and was shown to be stable by oral and intravenous glucose tolerance tests. In dogs that underwent total pancreatectomy under isoflurane anesthesia (GOI), blastogenesis of peripheral blood lymphocytes had a tendency to be reduced in comparison with no-treated dogs until 2 weeks after surgery. However, from 3 weeks after surgery, their responses became comparable to those of non-treated dogs. These results suggest that stable diabetes mellitus is induced, in dogs, by total pancreatectomy, and that this animal is a useful model of a pancreas transplantation recipient.

Animals↗

PubMed2005

Factitious hyperinsulinism leading to pancreatectomy: severe forms of Munchausen syndrome by proxy.

Clinical history and inappropriate insulin secretion during hypoglycemic episodes permit the diagnosis of hyperinsulinism. We report 2 cases of factitious hyperinsulinism leading to partial pancreatectomy. Case 1 was an 8-year-old girl who presented with severe hypoglycemia and elevated insulin and C-peptide levels. Catheterization of pancreatic veins was performed to localize the excess insulin secretion. Insulinoma was suspected, and partial pancreatectomy was performed. Ten days after surgery, severe hypoglycemia recurred with severely elevated plasma insulin levels (x100) but very low C-peptide plasma levels, suggesting factitious hyperinsulinemia. Hypoglycemic episodes before surgery were provoked by oral sulfonamides; postoperative episodes were caused by parenteral insulin. Falsified prescriptions for sulfonamides and insulin by the mother, a nurse, were found. Case 2 was a 6-month-old girl who presented with seizures and hypoglycemia but had a symptom-free interval of many months afterward. At 2 years of age, repeated hypoglycemic seizures and elevated insulin plasma levels suggested congenital hyperinsulinism. C-peptide plasma level, measured once, was normal, but blood sampling was performed 15 minutes after a hypoglycemic episode. Partial pancreatectomy was performed. Two weeks after surgery, hypoglycemic seizures recurred, and the patient was admitted for pancreatic vein catheterization. This investigation was performed during hypoglycemia and revealed high insulin levels and undetectable C-peptide levels, suggesting factitious hypoglycemia. Insulin/C-peptide ratio analysis is crucial to assess factitious hypoglycemia, although sulfonamide-induced hypoglycemia is not thereby detected. One percent (2 of 250) of all cases of hyperinsulinemic hypoglycemia in our unit have been identified as Munchausen syndrome by proxy. Atypical disease history should raise the question of factitious hypoglycemia.

Blood Glucose↗

PubMed1997

Downregulation of IGF-I mRNA expression during postnatal pancreatic development and overexpression after subtotal pancreatectomy and acute pancreatitis in the rat pancreas.

Insulin-like growth factors (IGFs) are important peptides involved in the regulation of cell growth and differentiation in many tissues. The ontogeny of IGF-I was examined in pancreata from 19-day rat fetuses, newborns and 5-, 11-, 26- and 70-day-old rats. For the regeneration studies two models were used: (i) 90% pancreatectomy was carried out and the rats were killed at 1, 2, 3 and 6 days after resection; (ii) acute pancreatitis was induced with caerulein (12 micrograms/body weight three times a day every 8 h for 2 days) and the rats were killed at 1, 2, 5, 7 and 9 days after the first injection. Total RNA was extracted by the guanidinium isothiocyanate method and Northern blots were performed using total RNA and labeled cRNA probes. Abundance of the different mRNA transcripts was estimated by densitometric scanning and normalized to the abundance of 18 S rRNA for each time point. Northern blot analysis during ontogeny showed four (0.8-1.2, 1.9, 4.7 and 7.5 kb) major transcripts in the rat pancreas and liver. Total IGF-I mRNA was 40-fold higher in the adult liver than in the adult pancreas. Moreover, in the liver, IGF-I mRNA levels were higher in the adult than in the fetus, whereas in the pancreas, the highest levels were observed around birth. During the first 3 days after pancreatectomy, a peak of maximal expression was observed after the second day. Densitometric analysis of each IGF-I mRNA species showed concomitant increases in all transcripts. After 6 days, all transcripts had returned to near-control values. IGF-I mRNA expression 2 days after pancreatectomy was 3.5-fold higher than in the newborn. During the first 2 days of acute pancreatitis induction, overexpression of IGF-I mRNA was observed. However, soon after the second day of caerulein treatment, the 7.5 kb transcripts remained elevated whereas those of the others regressed toward control values. Our results show that IGF-I mRNA is overexpressed in both models of pancreatic regeneration but downregulated in the normal adult pancreas.

Acute Disease↗

PubMed1982

Effects of pancreatectomy, tolbutamide and insulin on glucose fluxes in chickens.

The effects of pancreatectomy and of injection of insulin or Tolbutamide on glucose fluxes in chickens were examined. This was prompted by earlier observations that Tolbutamide seems not to require the presence of pancreatic insulin for its acute hypoglycaemic action in this species. Rates of appearance (Ra) and disappearance (Rd) of glucose were estimated by isotope dilution using [14C]glucose in single-injection experiments and [14C]glucose and [6-3H]glucose in priming-injection + constant-infusion experiments. Six hours after sub-total pancreatectomy (splenic lobe remained in situ), chickens were hyperglycaemic (16.7 v. 10-4 mmol glucose/1 in controls), had a larger sampled glucose pool (4.41 v. 3.10 mmol) and a higher average rate of glucose utilization (41.7 v. 33.3 micron mol/kg per min) than sham-operated controls as estimated in single-injection experiments. Tolbutamide (50 mg/kg injected i.v.) reduced Ra in intact chickens from 33.9 to 1.1 micro mol/kg per min and reduced Ra in pancreatectomized chickens from 42.2 to 10.2 micro mol/kg per min. in priming-injection + constant-infusion experiments tolbutamide again reduced Ra significantly. In all case Rd tended to fall, apparently as a result of the developing hypoglycaemia. tolbutamide did not affect the volume of extracellular fluid (sucrose space). In single-injection experiments , insulin (1 unit/kg injected i.v.) reduced Ra by 56% and transiently increased Rd by 39%. It was concluded that pancreatectomy and injection of insulin or tolbutamide produce responses in glucose movements in chickens that are qualitatively similar to those in mammals. In chickens the hypoglcaemic action of tolbutamide, which persists in the absence of the pancreas, depends on an inhibition of glucose release by the liver.

Animals↗

PubMed2004

Nesidioblastosis treated successfully by 85% pancreatectomy.

Nesidioblastosis is a rare disorder in pediatric surgery. It is caused by hypertrophy and hyperplasia of the islands of Langerhans, and can lead to persistent hyperinsulinemic hypoglycemia. If appropriate treatment is delayed there is a high risk of the development of cerebral palsy, impaired mental development, epilepsy or other forms of irreversible brain damage, so early detection and early treatment to stabilize serum glucose levels is essential. Initial treatment consists of nutritional management with administration of an adequate amount of calories along with drug therapy using diazoxide. In cases that are resistant to drug therapy a subtotal pancreatectomy is performed. Conventional recommended practice has been to perform a 95% pancreatectomy, however this can lead to the onset of diabetes due to abnormal pancreatic endocrine function. We report here a case of nesidioblastosis in which we performed an 85% pancreatectomy. Postoperative clinical course has been excellent, with no recurrence or impaired glucose tolerance during the four years since the operation.

Blood Glucose↗

PubMed2006

Five-year survival following a medial pancreatectomy for an invasive ductal carcinoma from the body of the pancreas.

We report a rare case of a patient who survived for 5 years after undergoing a medial pancreatectomy for invasive ductal carcinoma originating from the body of the pancreas. A 63-year-old woman was diagnosed as a small cancer of the pancreatic body, and surgery was performed. Even though the tumor was a carcinoma, its small size prompted us to perform a medial pancreatectomy with regional lymph nodes dissection. Additional chemoradiation was performed and, five years after surgery, the patient is well with no signs of recurrence. Medial pancreatectomy for invasive ductal carcinoma has not ever been reported. Furthermore, long-term survival after a lumpectomy for invasive ductal carcinoma has never been reported in the literatures. The current case suggests that long-term survival in patients with invasive ductal carcinoma of the pancreas may be associated with the pathological or biological features of pancreatic carcinoma.

Carcinoma, Pancreatic Ductal↗

PubMed1999

[Pancreatectomy and diabetes].

Post total pancreatectomy diabetes is a clearly defined form of unstable diabetes, requiring low doses of insulin, with frequent and severe hypoglycemic events. This is due to both deficiency of pancreatic glucagon, hormone of primary importance for hepatic gluconeogenesis and glycogenolysis, and exocrine failure. The management of this form of diabetes is difficult, involving exact correction of malabsorption and low doses of insulin. Whenever possible, partial pancreatectomy should therefore to be preferred. After partial pancreatectomy, the likelihood of diabetes depends on the volume of the remaining pancreas, the type of resection and above all the preexisting pancreatic status. Prevention of postoperative hyperglycemia could minimize the risk of long-term diabetes. Pancreatic cancer is a particular case: the onset of diabetes could be a manifestation of occult pancreatic cancer and glucose metabolism may improve after tumour excision with preservation of some pancreatic tissue.

Diabetes Mellitus↗

PubMedDate not supplied

[Intermediate resection and distal pancreatectomy for benign neoplasms of the pancreas: comparison of postoperative complications and costs].

The middle pancreatic resection for benign pathology of the pancreas has been proposed as an advantageous alternative to the distal pancreatectomy, even though the risk of complications is greater. The purpose of the present study is to compare the cost and intra and perioperative impact for the 2 procedures. All patients with benign neoplasia of the body and tail of the pancreas operated on from 1990-1999 were selected from our computer archives, 21 patients underwent an intermediate resection and 64 a distal pancreatectomy. Operative time, units transfused, perioperative complications, post-operative stay and cost were compared. Statistical analysis revealed that the 2 operations are not significantly different in the intra-operative period. Comparing serious complications, the percentage of pancreatic fistulas (33% vs. 11%; P < 0.03) and average hospital stay (21.2 +/- 11.7 days vs. 15.5 +/- 7.1 days; p = 0.009) are greater for the middle than distal resection, respectively. In cases with post-operative complications the hospital stay is even more significant (middle 31.8 +/- 10.3 days vs. 19.1 +/- 7.6 days; p = 0.0002). The economic margin of residual costs, calculated by using the difference of DRG (no 192) and average post-operative costs, is similar for the 2 procedures in cases with normal post-operative courses, (intermediate Euro 2890.02; distal Euro 3181.9), while in cases with complications (DRG no 191), the difference increases (intermediate Euro 8670.11; distal Euro 12788.94). The middle pancreatic resection in respect to the distal pancreatectomy presents a greater technical difficulty when you take into account the longer post-operative course, the increased difficulty in treating complications and the increased costs.

Adolescent↗

PubMedDate not supplied

Central (middle segment) pancreatectomy: a suitable operation for small lesions of the neck of the pancreas.

A 73-year-old male was worked up for persistent abdominal pain and found to have a 2.5 cm cystic lesion of the neck of the pancreas. At celiotomy the lesion was felt to be a benign cystic lesion and a central pancreatectomy consisting of removal of the lesion with one centimeter of pancreas on either side was performed. The proximal pancreatic duct was oversewn and the distal body and tail of the pancreas was drained into a Roux-en-Y limb of the jejunum. At present, there are 70 cases of central pancreatectomy published in the literature. Mortality of the operation is zero and the major complications of pancreatic fistula, delayed gastric emptying, pancreatitis and abscess, are all temporary and self limiting. Central pancreatectomy affords the opportunity to save normal pancreatic tissue thus avoiding the complications of exocrine pancreatic insufficiency, namely steatorrhea and endocrine pancreatic insufficiency namely diabetes.

Aged↗

PubMedDate not supplied

Peculiar glucagon processing in the intestine is the genesis of the paradoxical rise of serum pancreatic glucagon in patients after total pancreatectomy.

BACKGROUND/AIMS: Although glucagon has been detected even in the serum of totally pancreatectomized patients and the origin was suggested to be the intestine, the kinetics of glucagon are not well known after pancreatectomy. In the present study, we investigated the kinetics of glucagon and glucagon-related peptides in pancreatectomy patients and discuss the glucagon processes. METHODOLOGY: Ten patients who had undergone total pancreatoduodenectomy reconstruction using Billroth II type procedures (group PX) and 12 normal subjects (group C) were also enrolled in this study. All patients received a 75-g oral glucose tolerance test in the early morning fasting state. Serum glucagon levels were assessed using the glucagon specific C-terminal (immunoreactive glucagon: IRG) and nonspecific N-terminal (glucagon-like immunoreactivity: GLI) radioimmunoassays. The molecular forms of these glucagon-related peptides were also estimated using the gel filtration chromatography method before and after the oral glucose load. RESULTS: After the glucose load, serum GLIs were increased significantly in group PX suggesting that these were affected by the alimentary tract reconstructions. Serum IRGs were significantly increased in group PX, but decreased in group C after oral glucose load suggesting that these paradoxical increased responses in group PX might be associated with the insulin secretion deficiencies, but not associated with the alimentary tract reconstruction. CONCLUSIONS: The paradoxical rise in IRGs based on the findings of gel filtration chromatography in group PX were possibly due to the generated peculiar glicentin-like peptide from the glucagon precursor, preproglucagon, after total pancreatectomy, which might be processed in intestines in association with the insulin deficiencies.

Adult↗

PubMedDate not supplied

Spleen-preserving distal pancreatectomy for intraductal papillary-mucinous tumor (IPMT).

BACKGROUND/AIMS: Recently, the significance of preserving the spleen has received a lot of attention. Since our first trial and success of spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein for chronic pancreatitis, this procedure has been more frequently performed and reported. In this study, we introduce the technique and indications for the procedure for intraductal papillary mucinous tumor of the pancreas. METHODOLOGY: Nine patients underwent spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. We performed this procedure in two patients with intraductal papillary mucinous tumor. The splenic vein is identified behind the pancreas and within the thin connective tissue membrane. The connective tissue membrane is cut longitudinally above the splenic vein. An important technique is to remove the splenic vein from the pancreas from the body of the pancreas toward the spleen. There are many branches from the splenic vein on both sides, and these branches should be carefully ligated and cut. The pancreas is removed from the splenic artery from the spleen toward the head of the pancreas. This procedure is much easier than removing the pancreas from the vein. RESULTS: The postoperative course was uneventful in all nine cases, but one, in which pancreatic fistula continued for more than several weeks. The mean and standard deviation of the operative blood loss, the duration of the operation and the postoperative hospital stay in seven cases, excluding two cases, in which either Puestow's procedure or simultaneous subtotal esophagectomy was performed, were 413+/-385 mL, 298+/-55 min, and 39+/-15 days, respectively. Severe complications were not found in any of the nine cases. The two patients with intraductal papillary mucinous tumor have been followed as outpatients without any recurrence. CONCLUSIONS: Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein is easy and safe, and should be performed for some of the patients with intraductal papillary mucinous tumor of the pancreas.

Adult↗

PubMed2004

Central pancreatectomy as an indication for various benign pancreatic tumors.

Standard pancreatic resections, either proximal or distal ones, result in a considerable loss of pancreatic parenchyma and may cause impairment of the exocrine and endocrine functions. Central pancreatectomy has been indicated for small benign lesions located in the neck or body of the pancreas. It has the potential advantage of lowering the risk of functional impairment of the pancreatic parenchyma, biliary tract, upper gastrointestinal tract, and spleen. We present three cases of patients with benign, isolated pancreatic tumors who underwent a successful central pancreatectomy. From this small series, we believe that central pancreatectomy is an excellent therapeutic option for benign, localized pancreatic tumors.

Aged↗

PubMed2005

Pancreatectomy combined with superior mesenteric-portal vein resection: report of 32 cases.

BACKGROUND: Resection of the superior mesenteric-portal vein (SMPV) during pancreatoduodenectomy is disputed. Although the morbidity and mortality of patients after this operation are acceptable, survival is limited. In this study, we evaluated the morbidity, mortality and survival of patients with ductal adenocarcinoma of the pancreas who had undergone pancreatectomy with en bloc portal vein resection. METHODS: A total of 32 patients with ductal adenocarcinoma of the pancreas who had undergone pancreatectomy with SMPV resection between 1999 and 2003 were retrospectively analyzed. In addition, they were categorized into two groups according to the invasion of the wall of the portal vein: group A (n=12),extended compression of the wall of the portal vein by surrounding carcinoma without true invasion and group B (n=20), true invasion including intramural and transmural invasion. RESULTS: The morbidity of the 32 patients was 31.25%. There was no operative death, and the overall 1-,3-year survival rates were 59% and 16%, respectively. The mean survival time of patients with microscopically positive margin was only 5.6 months as compared with 20 months in patients with microscopically negative margin. No differences in tumor size, margin positivity, nodal positivity, and 1-, 3-year survival rates were observed between the two groups. CONCLUSIONS: If selected carefully, pancreatectomy combined with SMPV resection can be performed safely, without increase in the morbidity and mortality. SMPV resection should be performed only when a margin-negative resection is expected to be achieved. SMPV invasion is not associated with histologic parameters suggesting a poor prognosis.

Adult↗

PubMedDate not supplied

Laparoscopic distal pancreatectomy for neuroendocrine tumors of the pancreas.

Although neuroendocrine tumors of the pancreas are traditionally managed by laparotomy, these rare neoplasms may be amenable to laparoscopic surgical resection. We present our experience with laparoscopic distal pancreatectomy in two such patients, and discuss the operative technique with emphasis on organ preservation. Two female patients aged 63 and 69 years presented with clinical and biochemical features of an insulinoma and a vasoactive intestinal peptide secreting tumor (VIPoma), and were found on cross-sectional imaging to have 1.2-cm and 4.5-cm solitary tumors in the tail of the pancreas. They underwent laparoscopic distal pancreatectomy with and without preservation of splenic vessels and spleen respectively. Both procedures were completed laparoscopically. The operating time was 180 and 210 minutes respectively. There were no postoperative complications. The postoperative hospital stay was 4 and 14 days respectively. Histology revealed a benign insulinoma and a malignant VIPoma with lymph node metastases respectively. Laparoscopic distal pancreatectomy for neuroendocrine tumors of the pancreas may be accomplished safely, with preservation of the spleen and splenic vessels in benign disease, and with benefits to the patients in terms of postoperative recovery.

Aged↗

PubMed2006

[Laparoscopic distal pancreatectomy with preservation of the spleen].

OBJECTIVE: To summarize the experience of laparoscopic distal pancreatectomy with preservation of the spleen. METHODS: From Nov 2003 to Dec 2004, 2 patients with cystic lesions in the body and tail of the pancreas underwent laparoscopic distal pancreatectomy with preservation of the spleen. RESULTS: Both of the operations were successful with the operative time of 220 min and 190 min respectively, and the blood loss were 450 ml and 350 ml. There was no postoperative complication and the pathological diagnosis was pancreatic serous cystadenoma. Both patients' symptom disappeared after operation without recurrence during the follow-up of 18 and 5 months. CONCLUSION: Laparoscopic distal pancreatectomy with preservation of the spleen is safe and feasible for the management of benign tumor in the body and tail of pancreas with the advantages of reduced injury, earlier recovery and less complication.

Adult↗

PubMed2006

[Laparoscopic distal pancreatectomy: current indications and surgical results].

OBJECTIVE: To evaluate the safety, feasibility indications, prognosis and follow-up of laparoscopic distal pancreatectomy. METHODS: Retrospective study was employed on 10 patients collected from Feb. to Oct. 2005 with diagnosis of masses located at pancreatic body/tail. The mean age was 43 years and ratio between male and female was 1:9. Preoperative diagnosis: nine patients with cystic lesion located at pancreatic body and tail, one patient with pancreatic endocrine tumor with liver metastasis, which located at pancreatic tail. The mean size of the tumor was 4.0 cm. All patients received adjuvant examinations including CT contrast scan, abdominal ultrasound or endoscopic ultrasound. The serum levels of tumor markers (including CA19-9, CA242, CA50 and CEA) of the patients were all normal. RESULTS: All patients received distal pancreatectomy by laparoscope successfully. Among them, seven procedures were spleen-preserved and three with splenectomy. Mean operative time was 228 +/- 26 min, and mean blood lose volume was 173 +/- 100 ml. One patient suffered with pancreatic fistula after operation but was successfully managed by conservative therapy in one month, pancreatic pseudocyst was detected in one patient and disappeared spontaneously in one month, no other morbidity occurred. The postoperative hospital stay was 12 - 16 d (mean, 13.5 d). The serum glucoses of 10 patients after operation were normal. The mean time of follow-up was 8 months (2 - 22 months). During the follow-up, nine patients with benign cystic lesions did not relapse. And the other one patient with malignant metastasis kept stable, not recurrence was detected in one year after operation. CONCLUSIONS: Laparoscopic distal pancreatectomy was safe and feasible for benign cystic tumors located at the body or tail of the pancreas.

Adult↗

PubMed1991

[Changes of responses of gastrointestinal hormones after pancreatectomies].

In order to elucidate the changes of the gastrointestinal hormones (GIH), glucose and/or lipid were administered orally in 54 pancreatectomized patients, 22 gastrectomized patients and 28 healthy volunteers before and after the surgery. Peripheral plasma levels of cholecystokinin (CCK), neurotensin (NT), gastric inhibitory polypeptide (GIP) and pancreatic polypeptide (PP) were measured for 180 min by radioimmunoassay specific for each CIH. Hyperresponses of CCK, NT and GIP were observed before surgery in patients with tumor of the pancreatic head. The lack of bile in the alimentary tract was confirmed as one of causative factors for the hyperresponse of NT. No significant change was observed in response of CCK, NT, CIP and PP after caudal pancreatectomy. The responses of CCK and GIP were normalized after pancreatoduodenectomy (PD) or total pancreatectomy (TP). The response of PP was decreased after PD or TP. Such change of GIP was not noted after gastrectomy. These changes of GIH after pancreatectomies were considered to be caused by surgical removal of the structures in which these GIH mainly located.

Adult↗

PubMed1991

[Clinical and experimental studies on pancreatic functions and gastrointestinal hormones after major pancreatectomy].

The present study was undertaken to evaluate the changes of gastrointestinal hormones and pancreatic functions after major pancreatectomy in dogs and human. After more than 92% pancreatectomy in dogs, all dogs developed diabetes mellitus (DM). In these dogs, the remnant pancreas showed poor regeneration rate of 24.0% at 6 weeks, decreased sigma IRI in IV-GTT had not been recovered, pancreatic glucagon response was diminished, pancreatic exocrine function had been declined with increased plasma levels of secretin and CCK, and gastric secretion increased in spite of diminished gastrin response. After 74 to 92% pancreatectomy, 17.6% of dogs developed DM. The dogs with DM had poor pancreatic regeneration rate of 22.7% at 12 weeks, hypersecretion of glucagon and decreased gastric secretion with low plasma concentration of gastrin. On the other hand, in dogs without DM, pancreatic regeneration rate showed 42.7% at 12 weeks, insulin release and pancreatic exocrine function had been recovered well, and plasma CCK levels increased without changes of gastric secretion. In the clinical study, gastric secretion, CCK response and pancreatic endocrine and exocrine functions had been maintained better after pylorus preserving pancreaticoduodenectomy than after conventional pancreaticoduodenectomy.

Animals↗