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Results for “PANCREATECTOMY”

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PubMed1993

Isolated pancreatectomy for pancreatic head carcinoma using catheter bypass of the portal vein.

We investigated perioperative complications and survival rate in 114 patients with pancreatic cancer who underwent surgical resection between July, 1981 and March, 1992 with an antithrombogenic bypass catheter of the portal vein which we have developed. With this catheter, mesenteric venous blood can be bypassed to the systemic circulation or intrahepatic portal vein to prevent portal congestion or hepatic ischemia during portal obstruction or simultaneous obstruction of the hepatic artery. All the arteries supplying, and veins draining, the pancreas are dissected prior to its manipulation, following which isolated pancreatectomy accompanied by portal vein resection can be performed. Eighty patients (70%) also underwent isolated pancreatectomy. The perioperative death rate was 9.6%, and the main factor contributing to mortality with the bypass method was not portal vein resection, but various postoperative complications, such as insufficiency of the pancreatojejunostomy and thrombosis of the hepatic artery or superior mesenteric artery after resection and reconstruction. We conclude that aggressive surgery with the bypass method increases the operability of pancreatic cancer, although auxiliary therapies combined with radical surgery are necessary to improve the therapeutic outcome for this cancer.

Catheterization↗

PubMed1995

Distal pancreatectomy for cancer: results in U.S. Department of Veterans Affairs hospitals, 1987-1991.

Although cancers of the pancreatic body and tail are often advanced at the time of diagnosis, resection of localized tumors can result in long-term survival. A search of the computerized records of the U.S. Department of Veterans Affairs (DVA) revealed 29 distal pancreatectomies performed for pancreatic cancer from 1987 to 1991. Operative complications and survival data were available on all patients, and pathologic and staging information were retrieved on 21 patients, seven of whom had cancers other than pancreatic adenocarcinoma. Although 30-day mortality was high after distal pancreatectomy (21%), mean survival exceeded 1 year for patients with localized pancreatic adenocarcinoma and for those with histologies other than pancreatic cancer. Surgical resection should be offered to patients with lesions of the pancreatic body and tail when metastases are not demonstrated; survival will likely be prolonged when nodal or systemic metastases are absent. These recent DVA results from a wide variety of surgeons, hospital sizes, and university affiliations may more closely reflect the national experience with this operation in patients with cancer than do single institutional reports.

Humans↗

PubMed1996

Long-term complication following subtotal pancreatectomy for nesidioblastosis: a case report.

Nesidioblastosis is the most common cause of neonatal hypoglycemia. Although medical therapy has been attempted, it is generally accepted that these infants should undergo a subtotal to near total pancreatectomy with splenic preservation. Complications from this procedure have been few, most commonly those associated with decreased insulin production (diabetes). We describe a case of a young, white male who presented with complaints of hematemesis and melena 18 years following subtotal pancreatectomy for nesidioblastosis.

Adolescent↗

PubMedDate not supplied

Segmental pancreatectomy for the diagnosis and treatment of small lesions in the neck or body of the pancreas.

BACKGROUND/AIMS: To avoid any profound deficit in the pancreatic functions as well as to successfully make a histological diagnosis of such lesions, we performed resections of a small segment of the pancreatic neck or body. This article discusses the practicality of this procedure as well as the complications and evaluation of the pancreatic functions after surgery. PATIENTS AND METHODS: A segmental pancreatectomy was performed in patients with small lesions of the pancreatic neck or body. There were a total of 24 patients including 11 with hyperplasia, 7 with chronic pancreatitis, 4 with mucinous or serous cystadenoma, and each one with islet cell carcinoma (low-grade malignancy) and carcinoma in situ. RESULTS: No major complications occurred following surgery. The pancreatic endocrine and exocrine functions were well maintained in all patients except for two with chronic pancreatitis. CONCLUSIONS: Based on our findings, a segmental pancreatectomy for small lesions in the pancreatic neck or body seems to be a safe and effective procedure for minimizing the postoperative deficit in the pancreatic functions, while it also allows for an accurate diagnosis of lesions that are often difficult to differentially diagnose for malignancy.

Adult↗

PubMed1997

[Indication and results of pancreatectomy with combined resection of vessels for adenocarcinoma of the pancreas].

Of 192 patients who received pancreatectomy for invasive adenocarcinoma of the pancreas, 107 (55. 7%) underwent combined resection of vessels at Keio University Hospital and Tochigi Cancer Center, from July 1974 until March 1996. Vascular resections included the portal and/or mesenteric vein in 103, the common hepatic artery in 14, the superior artery in 2 and the celiac axis in 5 cases. The morbidity and mortality rate are 20.2%, 1.2% in the standard resected group and 23.1%, 5.6% in the vessel resected group, respectively. Comparison of the survival rate of curability A and B patients between two groups shows no significant difference. Six patients who underwent resection of the portal and/or mesenteric vein survived more than 5 years. The longest survivor is living 13 years 6 months after surgery. Among the patients who underwent resection of the artery, two patients survived 44 and 22 months after distal pancreatectomy with resection of the celiac axis and the common hepatic artery preserving whole stomach.

Adenocarcinoma↗

PubMed1997

[Management of diabetes induced by nearly total (95%) pancreatectomy with autologous transplantation of Langerhans cells].

The present report concerns a patient who had undergone nearly total pancreatectomy (95%) with pancreatic islet autotransplantation for intractable pain caused by obstructive chronic pancreatitis. Islets were prepared by a modified collagenase digestion and were cultured in vitro in Eagel's medium in 5% CO2 in air at 37 degrees C for 5 days. The resultant preparation, containing about 150,000 islets, was injected into the recipient's liver via the umbilical vein. No complication occurred from the pancreatectomy or transplant. Postoperatively, the patient had complete relief of the abdominal pain, and the insulin-independent condition remained with normal fasting blood glucose, and hemoglobin A1c for 11 months. Subsequently the fasting hyperglycemia was evident, and the patient began oral antidiabetic medication, but 2 year after transplantation the insulin-dependent condition demanded exogenous insulin (24 U). At present the fasting serum C-peptide level is 0.6 ng/ml and the HbA1c of 5.8% confirms the normoglycemic condition at the same insulin dose. Islet auto-transplantation should be considered as an adjunct procedure to prevent or ameliorate diabetes after total or nearly total pancreatic resection.

Adult↗

PubMed1997

Experiences with duodenum preserving pancreatectomy.

According to the principle of surgery for chronic pancreatitis the preservation of pylorus, duodenum or distal part of common bile duct gives the benefit of more physiological intervention. 2 patients with duodenum preserving pancreatectomy are presented. The operation was carried out for chronic pancreatitis. Both patients had jaundice and needed T drainage. Both patients suffered from very severe malnutrition with cachectic condition adding severe pain. None of them proved to be malignant by the frozen section. Previous diabetes, severe chronic inflammation of the whole pancreas, destruction of the pancreatic ductal system and cysts helped the decision-making for ablation of pancreas with preservation of duodenum which seems organ saving procedure. In comparison with the Whipple operation the duodenum-preserving pancreatectomy spares the patient a gastrectomy, a duodenectomy and a resection of distal common bile duct.

Cachexia↗

PubMedDate not supplied

Extended radical pancreatectomy for carcinoma of the head of the pancreas.

BACKGROUND/AIMS: Pancreatic cancer has a poor prognosis, which is, in part due, to the unfortunately advanced stage, in which the tumor is diagnosed. Since 1973, we have utilized a unique method of extended radical pancreatectomy, using the translateral retroperitoneal approach (TRA) to facilitate combined portal resection. The advantages of this operation are described herein, for patients with carcinoma of the head of the pancreas. In addition, the problems associated with this operation are discussed. METHODOLOGY: Survival was calculated based on type of resection, degree of invasion of the retroperitoneal tissues, degree of lymph node involvement, and cancer stage. Extensive surgery has been performed for pancreatic carcinoma 216 patients. Of these, 14 patients had carcinoma of the head of the pancreas. There were 58 patients who underwent macroscopically curative resections. RESULTS: Only 39 patients were microscopically curative. Ten of the patients who underwent microscopically curative resections, survived for 5 years (34.0%). There were no statistically significant differences in survival based on tumor size. However, there was a significant difference in survival based on extent of invasion of the anterior capsule of the pancreas, extent of invasion of the retroperitoneal tissue, extent of lymph node involvement, cancer stage, and extent of invasion at the surgical margin of resection. CONCLUSION: The results suggest that extended radical pancreatectomy may be indicated for the treatment of cancer of the head of the pancreas.

Adult↗

PubMed1998

Pancreatic carcinoma in remnant pancreas after pancreatectomy for mucinous cystadenoma.

There are very few benign or malignant diseases which arise in the remnant pancreas after pancreatectomy. Pancreatic carcinoma in the remnant pancreas after pylorus preserving pancreatoduodenectomy (PpPD) for mucinous cystadenoma in a 66-year-old Japanese man is reported in this paper. The patient underwent PpPD for a mucinous cystadenoma in the pancreatic head 39 months prior to the present operation. The surgical margins of the PpPD specimen were free from atypical cells. Follow-up ultrasonography revealed a hypoechoic lesion in the body of the remnant pancreas. Magnetic resonance cholangiopancreatography (MRCP) revealed a stenosis of the main pancreatic duct, with upstream dilatation in the remnant pancreas. Segmental resection of the remnant pancreas, splenectomy, pancreaticojejunostomy and intraoperative radiotherapy were performed under the diagnosis of pancreatic carcinoma of the remnant pancreas. Final histopathological diagnosis was adenocarcinoma of the pancreas. There were no malignant cystic components. The present pancreatic carcinoma was regarded as independent of the previous mucinous cystadenoma. Postoperative radiation therapy and chemotherapy were added. He is doing well 20 months after the second operation although diabetes mellitus has slightly deteriorated. In this communication, we would like to recommend that clinicians should constantly be on guard against the development of pancreatic carcinoma even in the remnant pancreas after pancreatectomy for mucinous cystadenoma.

Adenocarcinoma↗

PubMed2001

Subtotal pancreatectomy for hypoglycemia due to congenital hyperinsulinism: long-term follow-up of neurodevelopmental and pancreatic function.

OBJECTIVE: To evaluate neurodevelopmental status as well as endocrine and exocrine pancreatic function in children who have undergone subtotal pancreatectomy for hypoglycemia due to congenital hyperinsulinism. PATIENTS AND METHODS: Out of 15 identified patients, eight children (mean age 12.7 +/- 0.8 yr) participated in detailed psychometric testing and studies assessing glucose homeostasis, secretion of proinsulin, insulin, glucagon and C-peptide during a test meal. Additionally, a 24-h fast, glucagon challenge test, 72-h stool collection, and ultrasonography of the pancreatic remnant were performed. RESULTS: Five of the 15 initially identified children had seizure disorders, including two with mental retardation. Diabetes developed in two of 15 children. All eight children investigated in the present study had evidence for attentional control impairment and 50% had subnormal intellectual functioning. Two had symptomatic hypoglycemia during the 24-h fast, while one had an elevated fasting glucose concentration. Four children, including the latter patient, had proinsulin/insulin ratios resembling patients with type 2 diabetes. Exocrine pancreatic function was normal in all eight children. No correlation was found between pancreatic endocrine function and pancreatic remnant size, nor between multiple pre- and postoperative factors (i.e., age at diagnosis and surgery) and neurodevelopmental outcome. CONCLUSION: While severe mental retardation or diabetes occurred infrequently in our patient population compared with previous reports, all of the studied children had subtle anomalies in their cognitive performance tests and the majority had endocrine test results indicative of abnormal insulin secretion and stressed pancreatic beta cells. Although partial pancreatectomy remains the treatment of choice after medical therapy fails, improved therapeutic means are necessary to achieve better clinical outcome.

Journal Article↗

PubMed2006

[Surgical resection of a gastrointestinal stromal cell tumor by double enterectomy and partial pancreatectomy on a 13-year-old mixed breed dog].

Surgical resection of a gastrointestinal stromal cell tumor by double enterectomy and partial pancreatectomy on a 13-year-old mixed breed dog. A 13 year-old, male, mixed breed dog, has been presented for an abdominal mass. The exam showed the presence of an ileo-caeco-colic mass adhered to the distal portion of the pancreas and the mid duodenum. A double enterectomy and a partial pancreatectomy were carried out and a diagnosis of gastrointestinal stromal cell tumor has been established.

Animals↗

PubMed1991

[Regional pancreatectomy in tumors invading the portal vein].

The authors present the clinical history of a patient who underwent the first regional pancreatectomy performed in Panama. The patient had been operated on one year before and the tumor in the head of the pancreas had been considered unresectable at that time because it had invaded the portal vein. Since the patient was in excellent health and her diabetes and hypertension (diagnosed ten years before) were well controlled, the size of the tumor, as demonstrated in CAT scans, had not changed in one year and the biopsy of the tumor had characterized it as of neuroectodermic origin without regional lymph node involvement, it was decided to perform a regional pancreatectomy. The authors describe the different stages of the resection of the tumor and the anatomical reconstruction. They point out the recommendations of different schools of thought about the operation and report on the excellent results obtained in this patient.

Humans↗

PubMed1987

Ductal adenocarcinoma of the head of the pancreas: incidence of tumor involvement beyond the Whipple resection line. Histological and immunocytochemical analysis of 37 total pancreatectomy specimens.

Intrapancreatic tumor spread of ductal adenocarcinoma of head of pancreas was examined histologically in 37 total pancreatectomy specimens. Five to 10 tissue blocks were prepared from grossly tumor-free tissue of each pancreas and coded by anatomic location. Step sections from each block were analyzed for carcinoma in situ lesions, invasive carcinoma, and benign ductal lesions. Immunocytochemical staining with monoclonal antibodies (MAb) against carcinoembryonic antigen (CEA) and nonspecific cross-reacting antigen 95 (NCA 95) were used to help in discriminating carcinoma in situ from papillary duct hyperplasia. In 3 of 37 pancreatectomy specimens (8%) tumor was found to spread in continuity from the primary carcinoma into the body and tail. In two of these three cases with tumor beyond the usual Whipple resection line, the tumor was present as a "carcinoma in situ" lesion along the main pancreatic duct. Since discontinuous tumor growth was not observed, multicentricity of duct type adenocarcinoma seems to occur less frequently than was previously reported.

Adult↗

PubMedDate not supplied

Adjuvant therapies in extended pancreatectomy for ductal adenocarcinoma of the pancreas.

BACKGROUND/AIMS: The poor prognosis after pancreatic cancer resection is attributed to a high incidence of locoregional recurrence and hepatic metastasis. The present study was carried out in order to determine whether adjuvant therapies improve patient survival. METHODOLOGY: Preoperative irradiation and postoperative liver perfusion chemotherapy have been added to the extended pancreatectomy procedure, and a retrospective analysis of 111 patients was performed. RESULTS: Preoperative irradiation (n = 17) significantly decreased the incidence of locoregional recurrence but increased the incidence of hepatic metastasis, with no improvement in the 5-year survival rate (from 27% to 23%). In contrast, postoperative liver perfusion chemotherapy (n = 27) succeeded in improving the 5-year survival rate to 39% by significantly decreasing the incidence of hepatic metastasis. CONCLUSION: These data suggest that the patients' survival rate may be increased when these two types of adjuvant therapy are combined with extended pancreatectomy.

Adenocarcinoma↗

PubMed2006

Pancreatic fistula after distal pancreatectomy: predictive risk factors and value of conservative treatment.

HYPOTHESIS: Predictive factors of pancreatic fistula (PF) and the value of conservative management of PF following distal pancreatectomy (DP) are poorly known. DESIGN: Case series. SETTING: A university hospital referral center. PATIENTS: From 1991 to 2003, 175 patients underwent DP with routine drainage of the pancreatic stump and postoperative repeated measures in drainage fluid. Pancreatic fistula was defined as an amylase level in surgical drainage fluid more than 5-fold the serum level after postoperative day 5, or amylase-rich fluid collection. Computed tomographic scan was only done for suspicion of abdominal collection. Conservative management of PF included percutaneous drainage of abdominal collection and total parenteral nutrition or maintaining oral feeding in some patients with low-volume PF. INTERVENTION: Conservative management of PF after DP. MAIN OUTCOME MEASURES: Incidence of PF according to indication, concomitant splenectomy, additional procedure, texture of parenchyma, location of transection (neck vs body), and technique of stump suture (stapler vs hand sewn), including elective ligation of the main duct, transfusions, and prophylactic use of octreotide. RESULTS: There was no mortality. Forty patients (23%) developed PF, which was symptomatic in 25 patients (63%); computed tomographic scan identified an abdominal collection in 26 (65%). Multivariate analysis identified 2 predictive factors for PF: no elective ligation of the main pancreatic duct (odds ratio, 2.2 [95% confidence interval, 1.0-4.7]) and transection at the body (odds ratio, 2.1 [95% confidence interval, 1.1-5.5]). If none or both predictive factors were present, the observed rate of PF was 16% and 63%, respectively. Pancreatic fistula was managed conservatively in 38 patients (95%), including percutaneous drainage in 16, and by reoperation in 2. CONCLUSIONS: Pancreatic fistula following DP is more frequent in cases of pancreatic division at the body level and no elective ligation of the main duct. Routine drainage of the pancreatic stump does not prevent postoperative abdominal collections. Conservative management of PF is successful in 95% of cases.

Adolescent↗

PubMed1975

Further evaluation of total pancreatectomy.

The results of 64 total pancreatectomies performed at the Mayo Clinic between 1942 and 1973 have been reviewed. Improvement in recent results as compared to the previously reported series is probably related to improvements in operative techniques and in selection of patients with more favorable malignant lesions. The recent results are more favorable than those reported for a group of comparable patients undergoing standard Whipple procedures for malignant lesions at this institution. Diabetes was easily managed in 76% of patients. Hypoglycemia due to insulin sensitivity is the major problem, and ketoacidosis seldom occurs. Recognition of this has resulted in better management of diabetes with relatively small doses of insulin. The sequels of long-standing diabetes do not appear to be a problem. Gastrointestinal tract hemorrhage has been greatly decreased through the use of more extensive gastric resection.

Adenoma, Islet Cell↗

PubMed1980

Partial distal pancreatectomy with a hand-held CO2 laser. An experimental study.

Partial distal pancreatectomy was performed in dogs with CO2 laser. Results were compared with those obtained with use of diathermy and scalpel. Postoperative hyperamylasemia appeared in all the animals. The highest peaks in the laser and scalpel groups were found on the fifth postoperative day, after which they gradually returned to normal; the highest levels appeared in the diathermy group on the 21st day, and returned to normal only after 56 days. Pancreatography showed a sealed duct in the laser and diathermy groups although no duct ligation was performed. Histological study of the laser group disclosed initial thermal injury at the cut section with no damage to the nearby parenchyma, followed later by a smooth, thin scar. In the diathermy and scalpel groups, the injured zone became enlarged later by active parenchymal and interlobular inflammation in the underlying tissue.

Amylases↗

PubMed1985

Evaluation of techniques of controlling exocrine drainage after segmental pancreatectomy in dogs. Implications for pancreatic transplantation.

Pancreatic transplantation is hampered by difficulties in controlling exocrine drainage. Methods of controlling exocrine drainage were assessed in 30 dogs receiving right lobe pancreatectomy. In the sham group, laparotomy and dissection of the pancreas were performed. In the others, the duct was either left open, ligated, anastomosed to jejunal mucosa, or injected with 1.5 mL of either silicone rubber, Neoprene, or Prolamine. Serial serum glucose and amylase levels were obtained at regular intervals and pancreatic biopsies were performed at two and eight weeks for examination. Glucose homeostasis was maintained throughout the study period. All animals developed severe pancreatitis as shown by hyperamylasemia by the second postoperative day, which resolved in most animals by the tenth to 14th day. Animals were free of ascites, pancreatic abscesses, and pseudocysts. All methods of ductal obstruction as well as the open duct drainage led to islet and acinar fragmentation and fibrosis. Endocrine function was preserved in all groups. In three animals with patent ductal-jejunal anastomoses, the pancreas appeared normal. Duct-to-jejunum anastomosis was the preferred method to preserve pancreatic function and morphology.

Amylases↗