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At least 127 records · Page 7Linked to original sources

PubMed2006

Laparoscopic distal pancreatectomy: results of a prospective non-randomized study from a tertiary center.

BACKGROUND: Though laparoscopic distal pancreatectomy for benign conditions was first described in the early 1990s, it has not become as popular as other laparoscopic surgeries. Published literature on this topic consists of several case reports and a handful of small series. We present our experience, which, to the best of our knowledge, is the largest series reported to date. METHODS: Since 1998, 22 patients have undergone distal pancreatectomy at our institute. The technique of distal pancreatosplenectomy, as well as spleen-preserving distal pancreatectomy, is described. RESULTS: Four males and 18 females in the age range of 12-69 years underwent operation. Splenic preservation was possible in 7 patients. The tumor diameter ranged from 2.1 cm to 7.4 cm. The mean operating time was 215 min. The mean length of incision required for specimen retrieval was 3.4 cm. All patients were started on a liquid diet on the first postoperative day. The median hospital stay was 4 days. One patient developed a pancreatic fistula that was managed conservatively. At the end of an average follow-up of 4.6 years, no recurrence has been reported. CONCLUSIONS: Laparoscopic distal pancreatectomy is a safe procedure, with minimal morbidity, rapid recovery, and short hospital stay. In appropriate cases, splenic preservation is feasible.

Adolescent↗

PubMed1999

Ductal branch-oriented minimal pancreatectomy: two cases of successful treatment.

Two patients with intraductal papillary-mucinous adenoma of the pancreas were successfully treated by ductal branch-oriented minimal pancreatectomy. We propose this novel less invasive ductal branch-oriented pancreatectomy, as indicated for benign ductal ectasia of the pancreas. The cystically dilated branch duct is identified by intraoperative ultrasonography, intraoperative balloon pancreatography, and injection of indigocarmine into the cyst. The cystically dilated branch is resected from the surrounding pancreas together with minimal removal of the pancreatic parenchyma. The communicating duct and cutting margins are tightly ligated to prevent pancreatic juice leakage and fistula. A drainage tube is placed in the main pancreatic duct whenever possible. Histopathologic examination of the transected branch duct is necessary to check for mucosal extension of dysplastic epithelium. This ductal branch-oriented minimal pancreatectomy is the least invasive pancreatectomy and a suitable operation for branch-type ductal ectasia of the pancreas, which is usually benign.

Aged↗

PubMed2000

Hemorrhagic pseudocyst and pseudocyst with pseudoaneurysm successfully treated by pancreatectomy: report of three cases.

Hemorrhagic pseudoaneurysm of pancreatic pseudocyst is one of the serious complications of acute pancreatitis. We successfully treated three patients who had hemorrhagic pseudocyst and pseudocyst with pseudoaneurysm by pancreatectomy. Case 1 was 43-year-old Japanese man who had had several episodes of acute pancreatitis and was diagnosed with hemorrhagic pseudoaneurysm of the splenic artery in a pseudocyst in the pancreatic tail, shown on computed tomography (CT) and angiography. Transarterial embolization (TAE) yielded hemostasis of the pseudoaneurysm, but rebleeding occurred 2 weeks after the TAE. Distal pancreatectomy and splenectomy was successfully performed. Case 2 was a 64-year-old Japanese man who presented to us with several attacks of acute pancreatitis. Imagings showed bleeding pseudoaneurysm of the transverse pancreatic artery in a pseudocyst in the pancreatic body. Because of marked stenosis in the proximal portion of the transverse pancreatic artery, TAE was unsuccessful. Distal pancreatectomy and splenectomy was performed successfully. Case 3 was a 40-year-old Japanese woman who had a history of abdominal trauma. Imagings showed bleeding pseudoaneurysm of the splenic artery in a posttraumatic pseudocyst in the pancreas. TAE of the pseudoaneurysm was unsuccessful because of the proximity of the pseudoaneurysm and the splenic artery. Distal pancreatectomy and splenectomy was successfully performed and her postoperative outcome was satisfactory. Whenever interventional radiology (IVR) is not indicated or has failed, aggressive and immediate surgical intervention should be considered for early and definitive recovery in these patients.

Acute Disease↗

PubMed1998

Acute effects of distal pancreatectomy on portal and peripheral blood insulin concentrations in patients undergoing total gastrectomy.

The influence of distal pancreatectomy on portal and peripheral blood immunoreactive insulin (IRI) and immunoreactive glucagon (IRG) concentrations was evaluated in patients undergoing total gastrectomy. There were 22 patients studied, 12 of whom did not undergo distal pancreatectomy (group 1), and 10 who did (group 2). In group 2, the increase in portal blood IRI concentrations after a glucose infusion of 25 g over 30 min was suppressed, and reelevation of the portal blood IRG concentration after the glucose-induced depression was inhibited compared to group 1. In contrast, the peripheral blood IRI concentration did not reflect these changes in the portal blood IRI concentration. The rise in the arterial ketone body ratio (AKBR) and the fall in the total ketone body concentration after glucose infusion were also attenuated after distal pancreatectomy in group 2. These findings suggest that distal pancreatectomy has an immediate suppressive effect on the pancreatic secretion of insulin and glucagon, and might disturb metabolism in the liver.

Female↗

PubMed1976

Cancer of the pancreas. Palliative operation, Whipple procedure, or total pancreatectomy?

The choice of operation for ductal carcinoma of the pancreas is as yet not clear. Failure to make an early diagnosis still stands out as the major problem in the treatment of this disease and as a result the resectability rate is exceedingly low. Between 1964 and 1973, nineteen total pancreatectomies were performed at Peter Bent Brigham Hospital for all tumors of the pancreas. Sixteen of these were for ductal carcinoma. The mortality was 12.5 per cent. When total pancreatectomy is compared with the Whipple procedure and a simple bypass procedure and when the tumor disease encountered is corrected for stage of disease, it is apparent that total pancreatectomy carries a statistically significant longer survival for patients with Stages I and II disease (no lymph node involvement) than the other two procedures. For Stages III and IV, there is no difference in survival between the three different operations. We therefore conclude that total pancreatectomy carries a better survival prognosis than other procedures performed for Stage I and II ductal carcinoma of the pancreas.

Adult↗

PubMed1984

Effects of fasting, pancreatectomy, and hypophysectomy in the yellow eel, Anguilla rostrata.

Metabolic effects of pancreatectomy and hypophysectomy are investigated in the yellow American eel, Anguilla rostrata, fasted for 6 months. The results are compared with the findings in freshly captured eels subjected to the same operations. In intact animals, fasting causes a statistically significant decrease in serum amino acid nitrogen (AAN), serum urea, and relative liver weight, and an increase in serum free fatty acids (FFA), serum cholesterol, and tissue hydration. Serum glucose, liver and muscle glycogen, liver and muscle fatty acids, and abdominal fat stores do not show significant alterations. The absence of diabetes mellitus after pancreatectomy, seen in previous studies, is confirmed. However, pancreatectomy affects fewer parameters in fasting eels than in fed ones. After hypophysectomy, the situation is similar; only serum AAN shows an impact of the operation in fasted eels. As in freshly captured eels, surgical stress seems to affect almost all metabolic parameters. It appears that the smaller impact of both pancreatectomy and hypophysectomy in fasted eels reflects the reduced role of hormones in the state of lowered metabolism.

Amino Acids↗

PubMed1989

In vitro release of pancreatic hormones following 99% pancreatectomy in the chicken.

In vitro assessment was made of the hormone-release capability of splenic pancreatic tissue 16 days after adult chickens had 99% of the pancreatic mass surgically removed. The objective of this study was to evaluate if the enlargement of the splenic lobe remnant after 99% pancreatectomy was attended by alterations in the responsivity of hormone release and, if so, were such changes reflective of all pancreatic hormones. After a 24-hr fast, splenic lobe tissue was obtained from young adult chickens on Postoperative Day 16, diced into 18-22 mg cubes, and incubated in vitro in media containing varying amounts of glucose with or without added somatostatin (SRIF). At 15-min intervals, the tissue cubes were transferred to fresh media and samples of each medium measured for insulin, glucagon, and APP. Viability of the tissue after 75 min was tested by tissue response to added 5 mM phenylalanine. The results obtained indicated that while total content of all four hormones (including SRIF) increased with tissue enlargement, the concentration of each decreased significantly except for SRIF, which remained at control levels. Further, the sensitivity of the B-cell in releasing insulin when confronted by a glucose challenge was not altered by previous pancreatectomy, while that of glucagon release from the A-cell was depressed. A-cell responsivity to SRIF does not appear to be adversely affected by previous 99% pancreatectomy. APP release was least affected by SRIF addition to the media, although depression by high glucose occurred. It is concluded that differential alterations occur in chicken pancreatic hormone-releasing cells as a result of 99% pancreatectomy. The efficacy in maintaining low, but still adequate, plasma I/G molar ratios (reported earlier) by the splenic remnant tissue either reflects a remarkable functional readjustment to surgical removal of 99% of the pancreatic mass in chickens or, alternatively, suggests the existence of extrapancreatic sources of insulin and glucagon, but not APP.

Animals↗

PubMedDate not supplied

Central pancreatectomy with pancreaticogastrostomy for benign pancreatic pathology.

Benign lesions of the neck and proximal body of the pancreas pose an interesting surgical challenge. If the lesions are not amenable to simple enucleation, surgeons may be faced with the choice of performing a right-sided resection (pancreaticoduodenectomy) or a left-sided resection (distal pancreatectomy) to include the lesion, resulting in resection of a substantial amount of normal pancreatic parenchyma. Central pancreatic resection has been reported with Roux-en-Y pancreaticojejunostomy reconstruction; however, this interrupts small bowel continuity and obligates an additional anastomosis. We have reviewed our experience with central pancreatectomy with pancreaticogastrostomy (PG) for benign central pancreatic pathology. Between January 1999 and December 2002, 14 central pancreatectomies were performed with PG reconstruction. There were 7 women and 7 men with a mean age of 60.9 years. Five resections were performed for islet cell tumors, three were performed for noninvasive intraductal papillary mucinous neoplasms, two were performed for serous cystadenoma, and one each was performed for a simple cyst, pseudocyst, mucinous metaplasia, and focal chronic pancreatitis. Seven out of 14 patients experienced a total of 10 complications. Pancreatic fistulae manifested by drainage of amylase-rich fluid from the operatively placed drains developed in 5 patients (36%). Reoperation or interventional radiologic procedures were not required in any patient with a fistula. Postoperative follow-up demonstrated 13 out of 14 patients to be alive and well without evidence of pancreatic insufficiency. One patient died at home on postoperative day 57 of cardiac pathology. Central pancreatectomy with PG is a safe and effective procedure that allows for preservation of pancreatic endocrine and exocrine function without disruption of enteric continuity. The complication of pancreatic fistula was managed conservatively via maintenance of operatively placed drains.

Adult↗

PubMedDate not supplied

Distal pancreatectomy for resectable adenocarcinoma of the body and tail of the pancreas.

The study goal was to analyze outcome after distal pancreatectomy for three subtypes of adenocarcinoma to determine the role of en bloc resection in surgical management. A secondary aim was to identify those clinicopathologic factors correlating with survival in an analysis limited to ductal adenocarcinoma. Medical records of consecutive patients undergoing distal pancreatectomy for adenocarcinoma between 1987 and 2003 were reviewed. A comparative analysis was undertaken of the safety and outcome of patients undergoing standard and en bloc resections. Clinicopathologic factors for patients undergoing distal pancreatectomy for ductal adenocarcinoma were subjected to both univariate and multivariate survival analyses. Ninety-three patients underwent resection for ductal adenocarcinoma (66, 71%), mucinous cystadenocarcinoma (18, 19%), or adenocarcinoma associated with intraductal papillary mucinous neoplasm (IPMN) (9, 10%). En bloc resection was required in 33 (35%) patients. There was no operative mortality. Median survival was 15.5 months, 30.2 months, and 50.7 months for ductal adenocarcinoma, mucinous cystadenocarcinoma, and adenocarcinoma associated with IPMN, respectively. Patients undergoing en bloc resection had a higher overall complication rate, required more transfusions and more intensive care unit admissions, and had a higher rate of positive margins; however, there were no deaths. For ductal adenocarcinoma, tumor size greater than 3.5 cm, age greater than 60 years, and stage were factors that correlated with survival on a univariate analysis. None were significant on multivariate analysis. Four patients with ductal adenocarcinoma were actual 5-year survivors. While en bloc resections are associated with a higher rate of complications, the majority are self-limited and mortality is low. Resection, including adjacent organs, should be performed when appropriate. Long-term survival for patients with cystadenocarcinoma or IPMN-associated adenocarcinoma can be anticipated. While rare, long-term survival for patients with ductal adenocarcinoma after distal pancreatectomy can be achieved.

Adenocarcinoma↗

PubMed1998

[Medial pancreatectomy with pancreatogastric anastomosis in pancreatic neoplasms].

AIM OF THE STUDY: To report a personal series of ten patients who underwent a medial pancreatectomy with pancreaticogastrostomy for tumor of the pancreas. MATERIAL AND METHODS: An equal number of five patients had solid and cystic tumors. The solid tumors were all endocrine and included two cases of insulinoma and solitary cases of VIPoma, glucagonoma, and non-secreting tumor. Five patients had a cystic tumor which was in two cases a serous cystadenoma, and in the other cases, a mucinous cystadenoma, a solid pseudopapillary tumor, and a solitary hydatid cyst of the pancreas. The operative procedure included a middle segment pancreatectomy, a suture of the proximal pancreatic stump, an anastomosis of the distal pancreatic stump with the stomach and an external transgastric drainage of the distal main pancreatic duct. RESULTS: In the postoperative course, a sero-hematic collection close to the anastomosis occurred in four patients and required external drainage in three cases. All patients recovered without sequela of pancreatic dysfunction. CONCLUSION: This series confirms the place of medial pancreatectomy in resection of non-enucleable tumors of the middle part of the pancreas. It also shows that pancreaticogastrostomy is a technical simplification compared to Roux-en Y pancreaticojejunostomy in this particular modality of pancreatectomy.

Adolescent↗

PubMed2000

The feasibility of spleen-preserving pancreatectomy for end-stage chronic pancreatitis.

BACKGROUND: It is considered difficult to preserve the spleen at the time of distal or total pancreas resection for chronic pancreatitis (CP). The aim of this study was to assess the feasibility of preserving the spleen in patients requiring total or completion pancreatectomy for CP. METHODS: All patients having total or completion pancreatectomy for CP were evaluated postoperatively in terms of morbidity, mortality, and pain relief. To assess splenic vascularity, all patients underwent abdominal ultrasound and power doppler imaging to assess splenic perfusion and the patency of the remaining splenic vessels. RESULTS: Of 35 patients having total pancreatectomy, the spleen was preserved in 30 patients (19 women, 11 men; median age 40 years). The etiology of CP was mainly idiopathic (n = 14) or alcohol related (n = 12). All patients presented with chronic abdominal pain (median 5 years) requiring opiate-derived analgesia for pain relief. Fifteen patients (50%) had undergone previous therapeutic intervention for pain relief. The spleen was preserved with either an intact splenic artery and vein in 19 patients and or the short gastric vessels (n = 11). The mean duration of the procedure was 7 hours (range 5 to 11) and mean blood loss was 1,090 mL. The 30-day mortality was 3.8% (n = 1). Five patients had splenic complications (17%). These included splenectomy (n = 2), intrasplenic collection (n = 2), and a wedge splenic infarct (n = 1). Two of these complications were related to intrasplenic islet autotransplants. Follow-up with abdominal ultrasound and power doppler scanning showed no other abnormalities; blood flow was demonstrable in all patients with intact splenic arteries and vein (n = 19). The mean hospital stay was 25 days. Of the 24 patients who were beyond 6 months' follow-up, 82% (n = 20) have complete relief of pain, and 4 still require opiate analgesia. CONCLUSIONS: Spleen-preserving pancreatectomy is a feasible procedure for chronic pancreatitis, providing complete pain relief in 80% of patients. When the splenic artery and vein cannot be preserved, there is a minimal risk of splenic complications that may require further treatment; but for the majority of patients, splenectomy is avoided.

Adult↗

PubMed1996

Pitfalls of distal pancreatectomy for relief of pain in chronic pancreatitis.

PURPOSE: To examine whether preoperative computed tomography (CT) scans and pancreatograms can: (1) identify patients with chronic pancreatitis localized to the tail of the pancreas; and (2) select those patients who can obtain pain relief from a distal pancreatectomy. PATIENTS AND METHODS: Twenty patients were identified on whom the authors had performed distal pancreatectomy for relief of pain between January 1, 1991 and August 1, 1994. The results of surgery were classified as good, fair, or poor based on return to work and need for narcotics or rehospitalization. RESULTS: Eleven patients had good, 3 fair, and 6 poor results. All 7 patients with pseudocysts of the tail of the pancreas had good results, while 9 of 13 patients without pseudocysts had poor results. No other finding on CT scan, pancreatography, or laparotomy predicted successful pain relief by distal pancreatectomy. Furthermore, 3 patients had unexpected carcinoma found at the time of surgery. CONCLUSIONS: Even when anatomic evidence suggests that chronic pancreatitis primarily involves the tail of the pancreas and there is a stricture of the midpancreatic duct that is believed to cause the symptoms, distal pancreatectomy seldom provides sustained pain relief. Unsuspected carcinoma of the body and tail of the pancreas occurs frequently in this subset of patients with chronic pancreatitis.

Adult↗

PubMed2002

[Techniques, indications and early results of splenic preservation during left pancreatectomy].

STUDY AIM: Splenic preservation is rarely performed during left pancreatectomy. We compared retrospectively the early results of left pancreatectomy with and without splenic preservation to define the place of this procedure. PATIENTS AND METHODS: From 1979 to 1997, among 54 left pancreatectomies for another indication than adenocarcinoma, 13 were performed with and 41 without splenic preservation. The technique used for splenic preservation was prograde dissection of the left pancreas with (n = 4) and without (n = 9) preservation of both splenic artery and vein. The preoperative characteristics of the patients, peroperative data, postoperative morbidity and length of stay were compared. RESULTS: Mean operative time was longer with splenic preservation (262 +/- 67 min versus 215.6 +/- 59 min, p < 0.05), particularly in case of splenic vessels preservation (295 +/- 38 min, p < 0.02) whereas no difference was noted with splenic vessels ligation (240 +/- 76 min, p > 0.05). No mortality occurred. Prevalence of preoperative or postoperative haemorrhage, morbidity, or length of stay (intensive care unit and whole hospitalisation) did not differ with or without splenic preservation. Five patients developed pancreatic fistula without influence of splenic preservation: 1/13 (7.7%) versus 4/41 (9.7%); conversely, surgery following acute pancreatitis was associated with an higher risk of pancreatic fistula: 3/5 versus 2/49 (p < 0.005). No splenic necrosis occurred after splenic preservation. CONCLUSION: During left pancreatectomy, splenic preservation increases the operative duration (only in case of preservation of splenic vessels) but does not increase morbidity. This technique should be used whenever possible to allow long term immunological benefits of splenic preservation.

Acute Disease↗

PubMed2005

[Central pancreatectomy in benign tumors of the neck of the pancreas].

The surgical treatment of benign tumors of the neck of the pancreas usually consists of enucleation or formal pancreatectomy. Central pancreatectomy has been put forward because it has fewer major complications and can preserve endocrine and exocrine function. Between January 1999 and march 2003, three patients with benign tumors of the neck of the pancreas underwent central pancreatectomy. all patients underwent computed tomography scans, intraoperative ultrasound and frozen-section analysis. pathologic examination showed two mucinous cystadenomas and one serous cystadenoma. after a mean follow-up of 34 months, none of the patients has shown major complications or local recurrence, or has developed diabetes. In conclusion, central pancreatectomy is a useful technique for selected benign or low-grade malignant pancreatic tumors of the neck of the pancreas.

Adult↗

PubMed1988

Pancreatic exocrine and endocrine function after subtotal pancreatectomy for nesidioblastosis.

Pancreatic exocrine and endocrine function was assessed in seven patients 1 to 2 years after 95% pancreatectomy (group A) and three patients 9 to 11 years after 75% pancreatectomy (group B). In all cases surgery was undertaken for the treatment of hyperinsulinism and the histologic diagnosis was nesidioblastosis. The activities of pancreatic enzymes and bicarbonate concentrations were generally normal in group B, but were reduced in approximately half the children in group A. One child in group A had significant exocrine failure and poor weight gain. Blood glucose levels and fasting insulin levels were normal during a standard glucose tolerance test in all of the group B patients. One had a low fasting blood glucose level. In the group A patients three had low fasting glucose levels and one a frankly diabetic glucose tolerance test. C peptide and insulin levels were comparable but inappropriate insulin levels were noted in one patient, suggesting that the control of glucose-stimulated insulin release may remain abnormal. The results suggest that pancreatic function is not seriously impaired in the majority of patients 1 to 2 years after 95% pancreatectomy and that it is comparable to that noted in 75% pancreatectomy patients followed over a longer period of time.

Amylases↗

PubMed1996

Islet Autotransplantation after total pancreatectomy in a child.

Islet autotransplantation can prevent surgically induced diabetes after total pancreatectomy in adults; however, the efficacy of this procedure has not been established in children. The authors report the case of a 12-year-old boy who underwent total pancreatectomy and islet autotransplantation for intractable pain caused by idiopathic chronic pancreatitis. Islets were prepared from the excised pancreas by collagenase digestion and mechanical dispersion. The resultant preparation, containing 109,500 islets, was injected into the recipient's liver via the portal vein. No complication from the pancreatectomy or transplant occurred. Postoperatively, the patient had complete relief of abdominal pain. He remained insulin-independent, with normal fasting blood glucose and hemoglobin A1c levels, for 21/2 years. Preoperatively, the acute insulin response and the rate of glucose disappearance (Kg) were 213 microU/mL and 2.14% (respectively) after intravenous administration of 20 g of glucose. Although lower than pretransplantation values, both insulin response and Kg remained normal at 4 months (88 microU/mL; Kg, 1.01%); however, these decreased further, to below normal, by 2 years posttransplantation (10 microU/mL; Kg, 0.67%). Two-and-a-half years after transplantation, fasting hyperglycemia (> 200 mg/dL) was evident, and the patient was begun on exogenous insulin. Five years posttransplantation he remains insulin-dependent with a fasting serum C-peptide level of 0.20 ng/mL, which increased to 0.35 ng/mL in response to intravenous arginine, indicating sustained islet function. During the documented decreases in insulin secretion and Kg posttransplantation, the patient's body weight increased by 65% (from 34 to 56 kg) as a result of normal growth; the number of transplanted islets relative to body mass decreased accordingly, from 3,200 to 1,950 islets per kilogram of body weight. In this case, the number of islets transplanted likely could not meet the increased insulin demands of the larger body mass. Thus, exogenous insulin supplementation was needed to prevent hyperglycemia. In conclusion, insulin independence was initially established in a child by islet autotransplantation after total pancreatectomy. The failure of the islets to maintain normoglycemia long-term suggests that a sufficient number must be transplanted (to meet the demands of normal growth and development) for sustained insulin independence.

Blood Glucose↗

PubMed1997

Practical grouping of positive lymph nodes in pancreatic head cancer treated by an extended pancreatectomy.

BACKGROUND: Until recently long-term survival has not been expected when at least one positive node was detected at any site in pancreatic head cancer treated by conventional pancreatectomy. However, even when nodal involvement is seen, there has been an increasing number of long-term survivors after extended pancreatectomy in which a wide range of lymphatic and connective tissues were cleared. Thus the purpose of the present study was to establish a practical rational grouping of positive lymph nodes in pancreatic head cancer treated by extended pancreatectomy. METHODS: In 81 patients who tolerated extended pancreatectomy for cancer of the pancreatic head, a mean of 56 +/- 23 (range, 28 to 89) lymph nodes in each patient were examined under a microscope to determine the presence or absence of cancer. They were classified anatomically into 14 lymph node groups, and the incidence, distribution, and number of positive nodes were examined. A simplified grouping was made on the basis of the histologic findings and was checked against long-term survival rates. RESULTS: Nodal involvement was detected in 59 (73%) of 81 patients, and positive nodes were more commonly observed in the posterior pancreaticoduodenal (PPD), superior mesenteric (SM), and anterior pancreaticoduodenal (APD) groups than in the 11 other groups (p < 0.05). The PPD, APD, and SM groups offered the sole sites of nodal involvement with incidence levels of 23%, 17%, and 6%, respectively, whereas none of the 11 other groups did. Thus patients were classified into four groups: (a), negative in all 14 lymph node groups (n = 22); (b), positive but limited to the PPD/APD groups (n = 14); (c), also positive in the SM group, but negative in the 11 other groups (n = 13); and (d), also positive in at least one of the 11 other groups (n = 32). This classification was associated well with the 5-year survival rate: 59% in group (a), 53% in group (b), 15% in group (c), and 0% in group (d) [p < 0.05; group (b) versus group (c)]. Also this grouping associated well with the total number of positive nodes (p < 0.05). The 5-year survival rate in patients with one to three positive nodes was 47% and was more than 6% in patients with four to seven positive nodes (p < 0.05). CONCLUSIONS: In the clinicopathologic staging of the lymphatic spread from carcinoma of the pancreatic head, the PPD and APD groups were considered the first stations of lymphatic metastasis, whereas the 12 other groups-including the SM group-were categorized as second or more distant stations.

Humans↗

PubMed2000

Median pancreatectomy for tumors of the neck and body of the pancreas.

BACKGROUND: When enucleation is too risky because of possible damage of the main pancreatic duct, benign tumors located in the neck or body of the pancreas are usually removed by a left (spleno)-pancreatectomy or by a pancreatoduodenectomy. But standard pancreatic resection results in an important loss of normal pancreatic parenchyma and may cause impairment of exocrine and endocrine function. The aim of this study was to evaluate early and longterm results of median pancreatectomy, a limited resection of the midportion of the pancreas, in selected patients with benign or borderline tumors of the pancreas. STUDY DESIGN: Records of patients at Ospedale Busonera between November 1985 and September 1998 were reviewed. Ten patients with tumors of the neck or body of the pancreas underwent median pancreatectomy; the cephalic stump was sutured and the distal stump was anastomosed with a Roux-en-Y jejunal loop. Followup included clinical evaluation and routine laboratory tests: abdominal ultrasonography, exocrine and endocrine pancreatic function with fecal chymotrypsin, and an oral glucose tolerance test. RESULTS: Pathologic examination showed: insulinoma (n = 3), mucinous cystadenoma (n = 3), nonfunctioning endocrine tumor (n = 1), papillary-cystic neoplasm (n= 1), serous cystadenoma (n = 1), and intraductal mucinous tumor (n = 1). Operative mortality and morbidity were 0% and 40%, respectively; pancreatic fistula occurred in three patients. At mean followup of 62.7 months, no recurrence was found and no patient had exocrine insufficiency or glucose metabolism impairment. CONCLUSIONS: Median pancreatectomy is a safe and effective alternative to major pancreatic resection in selected patients with benign or low-malignant lesions of the pancreas. This procedure carries a surgical risk similar to that of the standard operation, but avoids extensive pancreatic resection and pancreatic function impairment.

Adolescent↗