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At least 19 recordsLinked to original sources
PubMed2003

Outcomes and indications of segmental pancreatectomy. Comparison with distal pancreatectomy.

BACKGROUND/AIM: To preserve pancreatic function, segmental pancreatectomy has been proposed for benign or low-malignancy tumors in the pancreatic body. Indications for the procedure, however, are still controversial. METHODS: In this study, we investigated the advantages and disadvantages of segmental pancreatectomy compared with distal pancreatectomy and subsequently determined indications for segmental pancreatectomy. RESULTS: The distal pancreatectomy patients had shorter operation times, lower incidence of operative complications, and shorter hospital stays compared to segmental pancreatectomy patients. Endocrine function in distal pancreatectomy patients deteriorated compared to that of segmental pancreatectomy patients. The postoperative 75-gram oral glucose tolerance test showed a diabetic pattern in 3 of 7 distal pancreatectomy patients, whereas none of the segmental pancreatectomy patients became diabetic after surgery. The relation between the length of the removed pancreas and plasma glucose at 2 h after the 75-gram glucose intake showed a significant correlation. CONCLUSION: According to our results, if the length of removed pancreas is longer than 12 cm, the patients will have a risk of acquiring diabetes. In those cases, the segmental pancreatectomy should be considered.

4-Aminobenzoic Acid↗
PubMedDate not supplied

Total pancreatectomy for intraductal papillary-mucinous tumor of the pancreas: reappraisal of total pancreatectomy.

BACKGROUND/AIMS: Total pancreatectomy is rarely performed as the treatment of pancreatic carcinoma because of markedly impaired quality of life and poor prognosis. Intraductal papillary-mucinous tumor (IPMT) of the pancreas is characterized by extensive intraductal spread and favorable outcome even in its invasive stage. The role of total pancreatectomy was reappraised in the treatment of IPMT. METHODOLOGY: A total of five Japanese patients with IPMT underwent total pancreatectomy and their clinical follow-up data were reviewed. RESULTS: Total pancreatectomy was performed due to massive involvement of the entire pancreas in two patients, positive surgical margins on frozen section in one, benign IPMT with concomitant pancreatic cancers in one and recurrent IPMT in the remnant pancreas after distal pancreatectomy for IPMT in the other. Three of them underwent total pancreatectomy of the Whipple type, another underwent total gastrectomy and the other underwent the pylorus-preserving method. Surgical margins were negative by histology and no lymph node metastases were evident. Two patients had severe infection including liver abscess in one and pneumonia in the other. The former died on postoperative day 82 and the latter was controlled by medical treatment and discharged on postoperative day 73. The other three patients had an uneventful postoperative course and were discharged from 29 to 62 days after the operation. Long-term follow-up of the four patients revealed that three patients had hypoglycemic attacks, two diabetic retinopathy and two fatty liver. The four patients were doing well from 683 to 4,140 days after the operation without signs of recurrence. CONCLUSIONS: Total pancreatectomy would be indicated as a treatment of benign or malignant IPMT with extensive involvement when patients' condition permits and gives a chance of cure, although careful long-term medical care and follow-up are essential.

Adenocarcinoma↗
PubMed1988

Subtotal duodeno-pancreatectomy for carcinoma of the head of the pancreas. Preliminary report of an alternative operation to total pancreatectomy.

For ductal carcinoma of the head of the pancreas and large periampullary carcinoma with wide infiltration into the head of the pancreas a subtotal duodeno-pancreatectomy with preservation of the pancreatic tail and spleen is introduced as an alternative to total pancreatectomy. A preliminary report of 38 operations shows a mortality of only 3% and a low morbidity. Diabetes mellitus increased from 17% preoperatively to 40% postoperatively, therefore, in 60% a normal carbohydrate metabolism was preserved. At present 5 of 20 patients (R0) with ductal cancer are alive and free of recurrence 18 to 55 months after the operation with a median survival of 12 months for all curatively resected patients. No negative influence on median survival time can yet be recognized. Subtotal duodeno-pancreatectomy was performed with a much lower operative risk than total pancreatectomy and seems to be as effective as total organ removal.

Adult↗
PubMed1991

Total pancreatectomy in a case of nesidioblastosis due to persisting hyperinsulinism following subtotal pancreatectomy.

Hypoglycemia with hyperinsulinism persisted in a newborn weighing 6410 g despite treatment with high doses of diazoxide and glucagon, as well as infusions of glucose and somatostatin. A subtotal pancreatectomy was performed after nesidioblastosis had been diagnosed on the basis of the laboratory findings. Due to the persistence of therapy-resistant hypoglycemia, a total pancreatectomy preserving the duodenum and the bile duct was done 6 weeks later. With insulin and pancreatic enzyme substitution the now 6-year, 9-month-old child has shown normal, age, appropriate development.

Female↗
PubMed2007

Spleen-preserving distal pancreatectomy with excision of splenic artery and vein: a case-matched comparison with conventional distal pancreatectomy with splenectomy.

BACKGROUND: The value of spleen preservation during distal pancreatectomy (DP) still remains controversial. Spleen-preserving DP with excision of the splenic artery and vein is a simplified technique for spleen preservation. The aim of this study was to compare the postoperative course of DP with or without splenectomy. PATIENTS AND METHODS: From 1990 to 2005, 38 consecutive patients with benign or low-grade malignant disease underwent a spleen-preserving DP operation with excision of the splenic artery and vein (Conservative Group). They were compared with 38 patients who underwent conventional DP with splenectomy over the same time period (Splenectomy Group) and who had been matched for age, American Society of Anesthesiologists (ASA) score, and pathological diagnosis. Postoperative courses were analyzed and compared between the Conservative Group and Splenectomy Group. RESULTS: Spleen preservation was effective in 36 of the 38 attempts (95%). Postoperative complications - in particular, infectious intra-abdominal complications - were significantly higher in the Splenectomy Group (34 and 18%, respectively) than in the Conservative Group (13 and 3%, respectively) (P = 0.03 and P = 0.02, respectively). The length of the surgery, perioperative blood loss or transfusions, perioperative mortality and length of hospital stay did not differ between the two groups. Univariate analysis showed that splenectomy was the only risk factor for postoperative complication. CONCLUSIONS: Spleen-preserving DP with excision of the splenic artery and vein is a fast, safe and effective procedure associated, in this series, with a reduction of postoperative complications relative to conventional DP with splenectomy. This technique should be considered in patients with benign or low-grade malignant disease of the pancreas.

Adult↗
PubMed2000

A novel technique for multiple pancreatectomies: removal of unicinate process of the pancreas combined with medial pancreatectomy.

Preservation of normal pancreatic tissue in the surgical treatment of benign tumors of the pancreas offers advantages over more extended pancreatic resections. Removal of the uncinate process of the pancreas with the preservation of Wirsung's duct allows resection of a localized tumor within the uncinate process of the pancreas, maintains the flow of pancreatic juice into the duodenum, and preserves the dorsal part of the head of the gland. A pancreatic duct stent is particularly useful to identify the pancreatic duct (Wirsung's duct) intraoperatively to avoid injury which causes postoperative pancreatic leak. We have developed and employed a novel technique whereby tumors are completely excised, in combination with medial pancreatectomy, for the management of multiple mucin-producing tumors of the pancreas localized in the uncinate process and in the body of the pancreas. The cut end of the head of the pancreas is closed by interrupted sutures. Reconstruction for the distal pancreas is effected with a Roux-en-Y pancreatico-jejunostomy to the tail of the pancreas. Recovery was uncomplicated in our patient, with no endocrine or exocrine pancreatic insufficiency after 2-year follow-up.

Adenocarcinoma, Mucinous↗
PubMed1990

An appraisal of pancreatectomy for advanced cancer of the pancreas based on survival rate and postoperative physical performance.

The follow-up results of surgical procedures for cancer of the pancreas at three affiliated hospitals during the past 15 years (1974-1989) were retrospectively analyzed to evaluate the merit of pancreatectomy in surgical treatment of advanced stages of this disease. Included were 4 cases of stage I, 14 cases of stage II, 19 cases of stage III, 43 cases of localized stage IV, and 35 cases of generalized stage IV. Pancreatectomy was performed in 67 cases; 100%, 92.9%, 89.5%, 67.4%, and 11.4% of the stage I, II, III, localized IV, and generalized IV cases, respectively. For the localized stage IV cases, in which the cancerous lesions were advanced but limited to the peripancreatic region, 29 pancreatectomies, 12 bypass operations, and 2 exploratory laparotomies were performed. This group included 17 curative and 12 noncurative pancreatectomies. The 50% survival periods were 257 days after curative pancreatectomy, 226 days after noncurative pancreatectomy, 120 days after bypass operation, and 33 days after exploratory laparotomy. The difference in overall survival rate between curative and noncurative pancreatectomies was not significant. The overall survival rates after both curative and noncurative pancreatectomies were significantly higher than the rate after bypass operation. The postoperative physical performance status after pancreatectomy was significantly better than after the palliative procedures. No significant difference in the status was found between patients after standard and extended pancreatectomies. There was no significant difference in the survival rates or the physical performance status between the pancreatectomy group and the palliative surgery group for the generalized stage IV cases, in which the cancerous lesions extended beyond the peripancreatic region. On the basis of these findings, it is concluded that pancreatectomy extends the postoperative survival period without impairment of the physical performance status in patients with advanced cancer of the pancreas. Even when the pancreatectomy proves to be a noncurative resection, this aggressive surgical approach may be of benefit to this group of patients. It should be noted, however, that pancreatectomy is not beneficial to patients whose lesions have already become generalized.

Adult↗
PubMedDate not supplied

Surgical treatment for serous cystadenoma of pancreas--segmental pancreatectomy or conventional resection?

BACKGROUND/AIMS: Benign tumors located in the neck or body of the pancreas are usually removed by left pancreatectomy or pancreaticoduodenectomy when enucleation is too risky for possible damage of the main pancreatic duct. But standard pancreatic resection has its potential operative risk and may result in loss of pancreatic parenchyme and cause impairment of pancreatic function. The aim of this study was to compare the results of segmental pancreatectomy, a limited resection of the mid-portion of the pancreas, and traditional extensive pancreatic resection, i.e. distal pancreatectomy or pancreaticoduodencetomy in patients with serous cystadenoma of the pancreas. METHODOLOGY: From January 1989 to February 2002, 19 patients with serous cystadenoma of the pancreas treated with pancreatic resection were reviewed. Among them segmental pancreatectomy was performed in 5 cases, distal pancreatectomy was carried out in 11, pancreaticoduodenectomy in 2 and total pancreatectomy in one patient. RESULTS: Operation time was significantly longer in segmental pancreatectomy than in distal pancreatectomy (P<0.001) and a greater blood loss was also noticed in the conventional resection. There was no operative mortality and the postoperative hospital stays were not different in any group. A higher rate of pancreatic fistula was encountered in segmental pancreatectomy, however all of the fistulas sealed off after conservative treatment. A trend of higher chance of developing postoperative diabetes was noticed in the conventional resection. Except for the patient who underwent total pancreatectomy no patient developed frank steatorrhea during long-term follow-up. CONCLUSIONS: Segmental pancreatectomy is a safe and technically feasible procedure in selected patients with benign pancreatic tumor. This procedure carries a similar surgical risk as that of standard operation, but avoids extensive pancreatic resection which in turn may preserve more pancreatic functions.

Adult↗
PubMed2001

Results of total pancreatectomy for adenocarcinoma of the pancreas.

HYPOTHESIS: Total pancreatectomy for infiltrating ductal adenocarcinoma is not superior to pancreaticoduodenectomy or distal pancreatectomy. DESIGN: A retrospective analysis of a prospective database of patients. SETTING: Memorial Sloan-Kettering Cancer Center, New York, NY. PATIENTS: All patients (n = 488) undergoing pancreatic resection. MAIN OUTCOME MEASURES: Duration of operation, estimated blood loss, complications, length of stay, number of positive lymph nodes, presence of a positive margin, and survival times were analyzed. RESULTS: Thirty-five patients were identified who underwent total pancreatectomy, 28 of whom had adenocarcinoma. Median length of stay was 32 days; 19 (54%) developed postoperative complications, of which 63% were infectious. Thirty-day mortality was 3% (1 patient). Median survival was 9.3 months (range, 0.6-172 months). There was no significant difference between patients with and without adenocarcinoma in terms of duration of operation, estimated blood loss, complications, length of stay, or number of readmissions. In patients with adenocarcinoma, margin or nodal status were not significant survival variables. Patients undergoing total pancreatectomy for adenocarcinoma had a significantly worse overall survival than those undergoing total pancreatectomy for other reasons (P<.001), or compared with a contemporaneous cohort with adenocarcinoma undergoing pancreaticoduodenectomy (n = 409) and distal pancreatectomy (n = 51) (7.9 vs 17.2 months; P<.002). CONCLUSIONS: Total pancreatectomy can be performed safely with low mortality; survival is predicted by the underlying pathologic findings: patients undergoing total pancreatectomy for adenocarcinoma have a uniformly poor outcome. Those undergoing total pancreatectomy for benign disease or nonadenocarcinoma variants can have long-term survival. In patients who require total pancreatectomy for ductal adenocarcinoma, the survival is so poor as to bring into question the value of the operation.

Adenocarcinoma↗
PubMed2006

Central pancreatectomy: a technique for the resection of pancreatic neck lesions.

HYPOTHESIS: Central pancreatectomy has been used sparingly because the spectrum of indications is quite narrow. Although historically used for traumatic pancreatic transection and chronic pancreatitis, it currently is reserved for selective management of pancreatic neck lesions that are benign or have low malignant potential. Varying morbidity rates have been published in the literature. Our objectives were to describe the technique and determine the safety and effectiveness of central pancreatectomy in the excision of benign or low-malignant potential lesions of the pancreatic neck. DESIGN: Retrospective clinicopathologic data review. SETTING: The Mayo Clinic surgical index was used to identify procedures matched for central, median, middle, or middle segment pancreatectomy. PATIENTS: Eight patients (4 men, 4 women) underwent central pancreatectomy between 1998 and 2004. INTERVENTION: Patients with pancreatic neck or proximal body masses underwent central pancreatectomy at the Mayo Clinic, Rochester, Minn. MAIN OUTCOME MEASURES: Patients were followed up closely for postoperative complications during the initial hospital admission. On follow-up, long-term endocrine and exocrine function were determined based on laboratory values and patient history. RESULTS: Abnormalities included 3 islet cell tumors, 2 serous cystadenomas, a mucinous cystadenoma, a lymphoepithelial cyst, and a recurrent liposarcoma. Mean tumor size was 2.8 cm and mean operative time was 4.8 hours with a mean blood loss of 381 mL. The most common complication was pancreatic leak (5 patients [63%]). Reoperation was necessary in 2 patients (25%), both secondary to hemorrhage. There was no mortality or new-onset diabetes mellitus. One patient transiently required oral pancreatic enzyme supplementation. CONCLUSIONS: Central pancreatectomy may preserve endocrine and exocrine function. While mortality is low, in our experience, central pancreatectomy is associated with a high complication rate. The most common complication is pancreatic leak. Caution is necessary when using central pancreatectomy in the treatment of pancreatic neck lesions. Surgeon experience is of utmost importance in this decision-making process as well as the technical aspects of central pancreatectomy. The precise role of central pancreatectomy in the management of benign or low-malignant potential lesions of the neck of the pancreas remains in evolution.

Adenoma, Islet Cell↗
PubMed1983

Effect of insulin replacement on intermediary metabolism in diabetes secondary to pancreatectomy.

Patients with diabetes due to pancreatectomy have metabolic features different from Type 1 (insulin-dependent) diabetes after insulin withdrawal. Whether or not glucagon by itself or combined glucagon-insulin absence are responsible for this metabolic behaviour is unknown. This study was carried out to evaluate the ability of insulin replacement to abolish differences between patients with Type 1 diabetes and patients with diabetes due to pancreatectomy. We studied the diurnal patterns of intermediary metabolites, free insulin, and glucagon using the Biostator (glucose-controlled insulin infusion system) and intensive subcutaneous insulin therapy in five patients after total pancreatectomy, five after partial pancreatectomy and seven patients with Type 1 diabetes. All were studied for 24 h after an overnight period of normoglycaemia. Insulin requirement was lower in the patients with total pancreatectomy than in patients with partial pancreatectomy or Type 1 diabetes during both types of insulin treatment (p less than 0.05). Blood glucose and free insulin were similar in all the groups in both conditions. Immunoreactive glucagon was higher in the patients with diabetes secondary to pancreatectomy than in Type 1 diabetic patients. However, glucagon levels did not increase after arginine infusion in the patients with total pancreatectomy, and column chromatography of blood samples from two totally pancreatectomized patients showed no significant levels of immunoreactive pancreatic glucagon. Non-esterified fatty acids and ketone bodies were similar during Biostator and intensive subcutaneous insulin therapy. By contrast, gluconeogenic precursors (lactate, pyruvate, alanine and glycerol) were higher in patients with total pancreatectomy than in patients with partial pancreatectomy and Type 1 diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Experimental study on carbohydrate metabolism and pancreatic endocrine function after pancreatectomy--influence of islet activating protein (IAP)].

The influences of IAP on the residual pancreatic endocrine function and carbohydrate metabolism after extensive pancreatectomy in the rat were studied with oral glucose tolerance test (OGTT), arginine tolerance test (ATT), and measurement of hepatic glycogen, and hepatic glycolytic enzyme activity, and histological examination, etc. Wistar male rats weighing around 300 g were divided into the groups with IAP treatment and without it, and in the group with IAP treatment IAP 10 micrograms/kg was administered without anesthesia via the tail vein. In each group 60 and 90% pancreatectomies were performed in accordance with Scow's method, and the simple laparotomy group was used as control. Slight abnormality of glucose tolerance was shown in 60% pancreatectomy. The abnormality became worse with time in 90% pancreatectomy. Glucagon secretion was not damaged markedly even after extensive pancreatectomy. IAP stimulated IRI secretory response and improved glucose tolerance in 60% pancreatectomy group. IAP showed no effect in 90% pancreatectomy group. IAP did not stimulate IRG secretory response after pancreatectomy. Hepatic glycolytic enzyme activity was high in the group with IAP treatment. From the above observation, it has been suggested that IAP may be indicated for the abnormal carbohydrate metabolism after pancreatectomy, if pancreatectomy is not too extensive.

Animals↗
PubMed1994

Isolated pancreatectomy for ductal carcinoma of the head of the pancreas.

Hepatic carcinoma recurrence in the early months after pancreatectomy for ductal carcinoma of the head of the pancreas is one of the major factors of the poor survival rate. Early hepatic recurrence might be caused by carcinoma cells entering the portal vein as a result of surgical manipulations. To deal with this problem, we devised a new operative procedure called "isolated pancreatectomy" in 1987. This method involves no-touch pancreatic resection combined with extensive retroperitoneal skeletonization. Both the feeding and draining vessels of the pancreatic carcinoma are ligated and divided prior to pancreatectomy. The confluence of the portal vein, the superior mesenteric vein, and the splenic vein is removed together with the pancreatic head. The wide surgical field thus obtained facilitates subsequent skeletonization of the retroperitoneum. We have experienced 71 cases of pancreatectomy for ductal carcinoma of the head of the pancreas among whom isolated pancreatectomy has been performed in 16 patients since 1987. In all cases, long-term survival was obtained in the patients undergoing curative and extended resection. The cumulative five-year survival rate for stages I and II was 40.7%, and that for stage III was 17.3%. After the introduction of isolated pancreatectomy, hepatic recurrence rates within six months and 12 months after pancreatectomy have dropped to 0% and 16.7%, respectively, from the 22.9% and 31.3% of the other pancreatectomy. The survival rate for the patients with stage III in isolated pancreatectomy significantly exceeded that obtained with other pancreatectomy.

Carcinoma, Ductal, Breast↗