ABSTRACT
Objective:To evaluate three-dimensional visualization technology (3D technic) used in laparoscopic spleen-preserving distal pancreatectomy for pancreatic benign or low-grade malignant tumors.Methods:Data of 28 patients with laparoscopic distal pancreatectomy at Beijing Hospital from Aug 2016 to Dec 2021 were retrospectively analyzed.Results:There were 12 patients assigned in 3D attempt compared to 16 patients undergoing ordinary laparoscopy. In 3D group, all 12 patients underwent successful spleen preserving distal pancreatectomy. While in control group only 5 cases were successful in spleen preserving procedure, the remaining 11 cases failed in spleen preserving ending up in distal pancreatectomy combined with splenectomy. The spleen preserving pancreatectomy rate in 3D group was higher than control group ( P<0.05). There was no significant difference in the operation time (202±53.8) min vs. (186.8±48.3) min, intraoperative blood loss (107.5±141.2) mL vs. (160.6±184.4) ml and the incidence of pancreatic leakage between the two groups ( P>0.05). Nor there was difference in the average postoperative hospital stay between the two groups [(9.6±2.5) d vs. (19.1±40.6) d] ( P>0.05). Conclusion:Three dimensional visualization technology can improve the success rate and safety of laparoscopic spleen preserving distal pancreatectomy in cases of benign and low-grade malignant distal pancreatic tumors.
ABSTRACT
Objective@#To investigate the clinical efficacy of Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer.@*Methods@#The retrospective cross-sectional study was conducted. The clinicopathological data of 47 patients with gastric cancer who were admitted to Fujian Medical University Union Hospital from September 2016 to June 2018 were collected. There were 37 males and 10 females, aged from 23 to 75 years, with an average age of 60 years. Patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) postoperative pathological examination; (4) follow-up. Follow-up was conducted by outpatient examination and telephone interview to detect postoperative survival of patients up to September 2018. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were expressed by M (range). Count data were represented as absolute numbers.@*Results@#(1) Intraoperative situations: 47 patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer, without conversion to open surgery. The operation time, hilar lymph node dissection time, volume of intraoperative blood loss, number of lymph node dissected, number of splenic hilar lymph node dissected, number of metastatic lymph nodes, number of metastatic splenic hilar lymph node were (225±36) minutes, (20±6) minutes, (40±27) mL, 40 (range, 17-112), 2 (range, 0-10), 2 (range, 0-29), 0 (range, 0-3). (2) Postoperative situations: time to first out-of-bed activities, time to first anal flatus, time to gastric tube removal, time to initial liquid diet intake, time to initial semi-liquid diet intake, time to drainage tube removal, and duration of postoperative hospital stay were (2.0±0.3)days, (3.4±0.9)days, (3.4±1.1)days, (4.8±1.0)days, (6.7±1.5)days, (8.5±2.5)days, and (12.0±8.3)days, respectively. Of 47 patients, 3, 2, 1, 1, and 1 were detected pulmonary infection, abdominal bleeding, anastomotic fistula, postoperative intestinal obstruction, and abdominal infection. There were 1, 5, and 2 patients with complications in grade Ⅰ, Ⅱ, and Ⅲ of Clavien-Dindo classification. There was no death in the postoperative 30 days. Two patients with abdominal bleeding were cured by intervene therapy, and patients with other complications were cured by conservative treatment. (3) Postoperative pathological examination: tumor diameter, cases with nodal or vascular or neural invasion, cases with differentiated and undifferentiated tumor (histological differentiation), cases in T1, T2, T3, T4 stages (T staging), cases in N0, N1, N2, N3 stages (N staging), cases in Ⅰ, Ⅱ, Ⅲ stages (TNM staging) were (4.2±1.6)cm, 26, 31, 16, 5, 22, 17, 3, 18, 9, 8, 12, 13, 20, 14, respectively. (4) Follow-up: 47 patients were followed up for 3-25 months, with a median time of 9 months. During the follow-up, 3 of 47 patients died of tumor recurrence, 1 had tumor-bearing survival, and 43 had tumor-free survival.@*Conclusion@#Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer is safe and feasible.
ABSTRACT
Objective To investigate the clinical efficacy of Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer.Methods The retrospective crosssectional study was conducted.The clinicopathological data of 47 patients with gastric cancer who were admitted to Fujian Medical University Union Hospital from September 2016 to June 2018 were collected.There were 37 males and 10 females,aged from 23 to 75 years,with an average age of 60 years.Patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy.Observation indicators:(1) intraoperative situations;(2) postoperative situations;(3) postoperative pathological examination;(4) follow-up.Follow-up was conducted by outpatient examination and telephone interview to detect postoperative survival of patients up to September 2018.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were expressed by M (range).Count data were represented as absolute numbers.Results (1) Intraoperative situations:47 patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer,without conversion to open surgery.The operation time,hilar lymph node dissection time,volume of intraoperative blood loss,number of lymph node dissected,number of splenic hilar lymph node dissected,number of metastatic lymph nodes,number of metastatic splenic hilar lymph node were (225±36) minutes,(20±6) minutes,(40±27) mL,40 (range,17-112),2 (range,0-10),2 (range,0-29),0 (range,0-3).(2) Postoperative situations:time to first out-of-bed activities,time to first anal flatus,time to gastric tube removal,time to initial liquid diet intake,time to initial semi-liquid diet intake,time to drainage tube removal,and duration of postoperative hospital stay were (2.0±0.3)days,(3.4±0.9)days,(3.4±1.1)days,(4.8±1.0)days,(6.7±1.5)days,(8.5±2.5)days,and (12.0±8.3) days,respectively.Of 47 patients,3,2,1,1,and 1 were detected pulmonary infection,abdominal bleeding,anastomotic fistula,postoperative intestinal obstruction,and abdominal infection.There were 1,5,and 2 patients with complications in grade Ⅰ,Ⅱ,and Ⅲ of Clavien-Dindo classification.There was no death in the postoperative 30 days.Two patients with abdominal bleeding were cured by intervene therapy,and patients with other complications were cured by conservative treatment.(3) Postoperative pathological examination:tumor diameter,cases with nodal or vascular or neural invasion,cases with differentiated and undifferentiated tumor (histological differentiation),cases in T1,T2,T3,T4 stages (T staging),cases in N0,N1,N2,N3 stages (N staging),cases in Ⅰ,Ⅱ,Ⅲ stages (TNM staging) were (4.2±1.6)cm,26,31,16,5,22,17,3,18,9,8,12,13,20,14,respectively.(4) Follow-up:47 patients were followed up for 3-25 months,with a median time of 9 months.During the follow-up,3 of 47 patients died of tumor recurrence,1 had tumor-bearing survival,and 43 had tumor-free survival.Conclusion Da Vinci robotic total gastrectomy combined with spleenpreserving splenic hilar lymphadenectomy for gastric cancer is safe and feasible.
ABSTRACT
Objective To compare the clinical efficacy of the distal pancreatectomy with spleen preservation and the splenectomy in pancreatic tail for the treatment of benign and borderline tumor. Methods A total of 37 patients with pancreatic benign and borderline tumor from January 2012 to De-cember 2014 in our hospital were treated by laparoscopic surgery.Eleven cases were received distal pan-createctomy with spleen preservation(spleen preserving group)and 26 cases were received resection of pancreatic tail with spleen containing(splenectomy group).Results The operation time of spleen preser-ving group and splenectomy group were(165.34 ± 12.25)mins and(170.72 ± 14.37)mins(P>0.05). The blood loss in the preserving spleen group(108.52 ± 13.11)ml was significantly less than that in the splenectomy group(186.25 ± 17.43)ml(P <0.05).The hospitalization time of the preserving spleen group(10.16 ± 2.11)d was significantly shorter than that of the splenectomy group(12.78 ± 2.78)d(P<0.05).The use of Octreotide in the preserving spleen group(11.45 ± 3.75)mg was significantly less than that in the splenectomy group(16.75 ± 5.75)mg(P <0.01).All patients were followed up for three years.The disease free survival(DFS)in the spleen preserving group was higher than that in the splenecto-my group(100% vs.88.46%)with P<0.05.Conclusion The distal pancreatectomy with spleen preser-vation is safe,effective and suitable for pancreatic benign and borderline tumors.
ABSTRACT
Objective To study the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) in the treatment of pancreatic benign and borderline tumors.Methods The clinical data of 15 patients with preoperative diagnoses of pancreatic benign or borderline tumors who underwent LSPDP in the Jinhua Hospital,Zhejiang University from March 2013 to March 2017 were retrospectively analyzed.The diameter of tumors ranged from 2.6 to 6.8 cm,with an average of 4.4 cm.Results 15 patients were successfully treated with LSPDP.Twelve patients underwent splenic vessels preservation and 3 without splenic vessels preservation.The average operation time was 215 min (160 ～ 270 min).The mean intraoperative blood loss was 340 ml (180 ～700 ml),and the average postoperative hospital stay was 10.5 days (7 ～ 16 days).There was no patient with postoperative abdominal hemorrhage.Three patients developed postoperative pancreatic fistula and they were treated successfully with conservative therapy.Two patients developed splenic infarction,and the splenic infarction improved markedly after two months on CT.The pathological diagnoses showed 9 patients with serous cystadenoma,4 patients with mucinous cystadenoma,1 patient with a pancreatic neuroendocrine tumor and 1 patient with a solid pseudopapillary tumor.There was no recurrence on follow-up which ranged from 6 to 24 months.Conclusions Laparoscopic spleen-preserving distal pancreatectomy was safe and feasible in the treatment of pancreatic benign or borderline tumors.The Kimura procedure should be performed in preference to the Warshaw procedure.
ABSTRACT
Objective To investigate the clinical efficacy of laparoscopic spleen-preserving distal pancreatectomy (Kimura method and Warshaw method) for benign lesions of pancreatic body and tail.Methods The retrospective cohort study was conducted.The clinicopathological data of 39 patients with benign lesions of pancreatic body and tail who underwent laparoscopic spleen-preserving distal pancreatectomy in the Second Affiliated Hospital of Nanchang University between March 2008 and January 2018 were collected.Of 39 patients,28 undergoing Kimura method (splenic artery and vein-preserving distal pancreatectomy) were allocated into the Kimura group,and 11 undergoing Warshaw method (cutting splenic vessels and preserving short gastric vessels)due to serious adhesion between pancreatic body and tail and splenic hilum were allocated into the Warshaw group.Observation indicators:(1) operation situations;(2) postoperative situations;(3) follow-up situations.Followup using outpatient examination and telephone interview was performed to detect blood glucose level and tumor recurrence of patients up to March 2018.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range) and comparison between groups was done using nonparametric rank-sum test.Comparisons of count data were analyzed using chi-square test or Fisher exact probability.Results (1) Operation situations:39 patients received laparoscopic spleen-preserving distal pancreatectomy,operation time and volume of intraoperative blood loss of 39 patients were respectively (194 ±58)minutes and 100 mL (range,30-800 mL).The operation time and volume of intraoperative blood loss were respectively (197±56)minutes,100 mL (range,30-800 mL) in the Kimura group and (186±63)minutes,150 mL (range,30-450 mL) in the Warshaw group,with no statistically significant difference between groups (t =0.494,Z =-0.597,P＞ 0.05).(2) Postoperative situations:time to anal exsufflation and duration of hospital stay were respectively (2.6±0.8)days,(9.2±7.3)days in 39 patients and (2.4±0.6)days,(7.5±4.2)days in the Kimura group and (2.8±1.3)days,(13.5±11.1)days in the Warshaw group,with no statistically significant difference between groups (t=-0.720,-1.736,P＞0.05).Seven patients had postoperative complications.The incidence of complication was 2/28 in the Kimura group,1 patient with pancreatic leakage at 5 days postoperatively was cured by 15-day B ultrasound guided catheter drainage,and 1 who was diagnosed as pulmonary infection by chest CT examination at 5 days postoperatively was discharged from hospital after 8-day anti-infection and sputum-inductive treatments.The incidence of complication was 5/11 in the Warshaw group,3 patients with sustained fever at 5 and 7 days postoperatively who were diagnosed as grade 1 splenic infarction by epigastric enhanced CT examination were improved and discharged from hospital by antibiotic and low molecular weight heparin treatments,and then epigastric enhanced CT re-examination at 3 months postoperatively showed recovery of splenic perfusion;1 with pancreatic leakage at 7 days postoperatively was cured by 18-day conservative treatment;1 who was diagnosed as delayed gastric emptying by upper gastrointestinal contrast at 16 days postoperatively was improved and then discharged from hospital by 15-day placement of intestinal feeding tube and nutrition support therapy.There were statistically significant differences in the incidences of overall complication and splenic infarction between groups (x2 =5.485,4.878,P＜0.05) and no statistically significant difference in the incidence of other complications between groups (P＞0.05).(3) Follow-up situations:39 patients were followed up for 12 months (range,2-64 months).During the follow-up,six patients had normal blood glucose level,and all patients had good quality of life,without recurrence.Conclusions Laparoscopic spleen-preserving distal pancreatectomy for the benign lesions of pancreatic body and tail is satisfactory in short-and long-term curative effects.The incidences of complication and splenic infarction of Kimura method are lower than that of Warshaw method.
ABSTRACT
Objective To evalute the indication and clinical application value of microwave abla-tion in spleen-preserving surgery in treament of patients with traumatic rupture.Methods The clinical data of 45 patients with traumatic splenic rupture were retrospectively analyzed.Spleen preserving surgery was feasible by preoperative CT evaluation and intraoperative observation.36 patients received simply mi-crowave ablation,and 9 cases received microwave ablation assisted partial splenectomy.Postoperative com-plications were observed,and the changes of platelet in peripheral blood were detected before and after op-eration in the 3 th,7th,14th day to evaluate the function of spleen.Results 15 patient was complicated with left pleural effusion,1 patient was complicated with splenic fossa fluid associated with infection.Dur-ing the follow-up of at least 2 months,No patients had postoperative bleeding,hemoglobinuria,gastrointes-tinal leak,deep vein thrombosis and pancreatic leak complications,no deaths.Seven days after microwave ablation spleen-preserving surgery,blood platelet count were significantly higher than the levels before the operation (P 0.05).The CT scan and the ultrasonic examina-tion that reviewed after operation in the 30-60th day showed good in spleen imaging in spleen-preserving patients,No patients had portal vein thrombosis.Conclusion Microwave ablation spleen-preserving sur-gery in the treatment of partial traumatic splenic rupture will be a safe and effective operation which could expand the spleen-preserving indication and be used in clinical practice.
ABSTRACT
Splenic hilar lymph node must be dissected in D2 dissection for advanced upper gastric cancer.With the advances of surgical technology and updated treatment concept,spleen-preserving splenic hilar lymph node dissection has been widely accepted and gradually carried out by surgeons.However,laparoscopic spleen-preserving splenic hilar lymph node dissection has become a technical difficulty of laparoscopic surgery for gastric cancer due to complex anatomy of splenic hilar vessels and exposed difficulty in splenic hilar region,especially in obese patients.Surgeons not only have skillful laparoscopic techniques but also know anatomic characteristics of splenic hilar vascular well,and reasonable surgical approach and programmed surgical procedures can guarantee successful laparoscopic spleen-preserving splenic hilar lymph node dissection.Meanwhile,with the development of laparoscopic spleen-preserving splenic hilar lymph node dissection,there is also some disputes about lymph node dissection.
ABSTRACT
Objective To investigate the feasibility of spleen-and splenic vessels-preserving laparoscopic distal pancreatectomy for the treatment of pancreatic cystic tumor of body and tail.Methods The clinical data of a female patient with pancreatic cystic tumor of body and tail who was admitted to the Sun Yat-Sen Memorial Hospital of the Sun Yat-Sen University in March 2013 were retrospectively analyzed.Spleen-and splenic vesselspreserving laparoscopic distal pancreatectomy was determined as the optimal therapeutic method according to the physical examination and the results of computered tomography scan.Laparoscopic or open operation combined with distal pancreatectomy and splenectomy would be carried out as a candidate choice once it is hard to separate the splenic artery and vein from distal pancreas or to control the serious vessels hemorrhage.The patient was followed up by outpatient examination every 1 to 3 months up to March 2015.Results Spleen-and splenic vessels-preserving laparoscopic distal pancreatectomy was finished successfully.The operation time and volume of intraoperative blood loss were 192 minutes and 50 mL,respectively.The patient took out-of-bed for activity at postoperative day 1 without complications.The multiple severe microcystic pancreatic adenoma was confirmed by postoperative pathological examination,with a maximum diameter of 3.5cm.The leakage tube was removed at postoperative day 5.The levels of serum amylase at postoperative day 1,3,5 were normal.The patient was discharged at postoperative day 8 and got regular follow-up without bleeding,pancreatic fistula,infection and a symptom of epigastric pain or discomfort.Conclusion Spleen-and splenic vessels-preserving laparoscopic distal pancreatectomy has advantages of less traumas,faster postoperative recovery and a preservation of normal splenic function,deserving clinical application.
ABSTRACT
Laparoscopic spleen-preserving distal pancreatectomy has been widely performed for benign and borderline malignancy in the body or tail of the pancreas when there are not oncologic indications for splenectomy. As the need for minimally invasive procedures to reduce postoperative morbidity and improve the quality of life is increasing, many surgeons have attempted to reduce the number of trocars and incision size to minimize access trauma and scarring. Single-port laparoscopic spleen-preserving distal pancreatectomy is the result of these efforts; however it has many limitations such as technical difficulty and prolonged operation time. In this article, we report the first case of dual-incision laparoscopic spleen-preserving distal pancreatectomy, proving that it can be a safe and feasible minimally invasive procedure for benign or borderline malignant tumors in the body or tail of the pancreas.
Subject(s)
Cicatrix , Laparoscopy , Pancreas , Pancreatectomy , Quality of Life , Splenectomy , Surgical InstrumentsABSTRACT
With the maturation of laparoscopic surgical technology and the development of surgical instruments,the scope of application for laparoscopie surgery has expanded constantly in recent years.It is now possible to perform total laparoscopic distal pancreatectomy (TLDP).Cuschieri succeeded in performing laparoscopic distal pancreatectomy and slpenectomy in 1996,and in the same year,Kimura successfully performed spleen-preserving laparoscopic distal pancreatectomy.However,few successful spleen-preserving TLDP cases have been reported domestically or abroad.We made a success in a case of spleenpreserving TLDP with preservation of the splenic artery and vein in 2011,and the experiences of this surgical approach were introduced.
ABSTRACT
To summarize the evolution of spleen surgery and prospects the future. The knowledge on the splenic function (anti-infection, cancer and certain blood effects)gradually promotes the reform of spleen surgery in clinical practical, resulting all kinds of spleen-preserving surgery when splenic injury. However,there is still controversy about spleen removal or reservation under the condition of portal hypertension in liver cirrhosis patients, because advantages and disadvantages between these different operations. Laparoscopic splenectomy is a major progress in recent years,the standard operation need to be further explored. Spleen transplantation in the treatment of hemophilia A is one of the characteristics of the spleen surgery in China, and this is the leading position in the world, now we will focus on how to prevent chronic spleen graft dysfunction. To keep the advanced international level, Chinese teams on spleen surgery are still required to deepen the related research and strengthen the academic communication in the future.
ABSTRACT
PURPOSE: We would like to assess the safety and feasibility of extended spleen-preserving distal pancreatectomy with segmental resection of both splenic vessels (SPDP-SRSV) in patients with large, benign and borderline malignant pancreas body tumors. METHODS: We encountered seven extended SPDP-SRSV cases from January 2006 to March 2010. Among them, three were excluded due to combined pylorus-reserving pancreaticoduodenectomy (PPPD). For the extended surgical technique, the pancreas was divided above the confluence of the superior mesenteric vein-splenic vein-portal vein (SMV-SV-PV), and vascular control was achieved at the origin of the splenic artery and the junction of the splenic vein with the SMV. The segments of both splenic vessels were then extracted along with the specimen. RESULTS: All the patients were female with a median age of 57 years (range: 24~70 years). The median tumor size was 5.5 cm (range: 5~11 cm), the median operation time was 362 minutes (range: 337~441 min), the median estimated blood loss was 150 ml (range: 50~300 ml) and the median hospital stay was 9 days (range: 7~20 days). One patient underwent robot-assisted extended Warshaw procedures. No mortality was noted, but one partial intestinal obstruction occurred and this was resolved with conservative management. On the recent follow-up, the CT scans showed no evidence of tumor recurrence or spleen infarction, but newly developed perigastric varix was noted, but it was without variceal bleeding. CONCLUSION: SPDP-SRSV with division of the pancreatic neck portion above the confluence of the SMV-SV-PV in patients with large, benign and borderline malignant pancreatic body tumors appears to be an ideal approach because of the expected long-term survival and preserving the role of the spleen.
Subject(s)
Female , Humans , Follow-Up Studies , Infarction , Intestinal Obstruction , Length of Stay , Neck , Pancreas , Pancreatectomy , Pancreaticoduodenectomy , Recurrence , Spleen , Splenic Artery , Splenic Vein , Varicose Veins , VeinsABSTRACT
PURPOSE: Distal pancreatectomy has historically been accompanied by splenectomy, due to the proximity and common blood supply of the pancreas and spleen. However, spleen-preserving distal pancreatectomy was introduced in order to prevent postoperative sepsis. The aim of this study was to evaluate the feasibility and outcomes of spleen and splenic vessel preservation during laparoscopic distal pancreatectomy (LDP). METHODS: Between June 2004 and March 2007, 30 patients underwent LDP for pancreatic neoplasms. Preservation of both the spleen and splenic vessels was pursued for benign and borderline malignant tumors. RESULTS: There were 11 male and 19 female patients, with a mean age of 47 years (range; 24~79 years). In 4 patients with suspicious malignancy, the spleen and its vessels were sacrificed. Preservation of the spleen and its vessels was successfully performed in 20 of 26 patients (76.9%) in whom it was initially sought. The mean tumor size was 4.3 cm (range; 1.5~11 cm), the mean operation time was 231 min (range; 70~490 min), and the mean blood loss was 316.67 ml (range; 50~1000 ml). During LDP, no conversion to open surgery occurred. The mean hospital stay was 11 days (range; 6~23 days). There was no mortality or reoperation. Postoperative complications occurred in 9 patients (30%), but all patients recovered after conservative management. CONCLUSION: LDP is a relatively safe and feasible procedure for the management of benign or borderline malignant tumors of the distal pancreas. Preservation of the spleen and splenic vessels may be feasibly pursued during LDP.
Subject(s)
Female , Humans , Male , Conversion to Open Surgery , Glycosaminoglycans , Laparoscopy , Length of Stay , Pancreas , Pancreatectomy , Pancreatic Neoplasms , Postoperative Complications , Reoperation , Sepsis , Spleen , SplenectomyABSTRACT
Until now, there have been few reports of laparoscopic spleen preserving distal pancreatectomies with the conservation of the splenic vessels. We experienced two cases of a laparoscopic spleen preserving distal pancreatectomy, with the conservation of the splenic artery, vein and short gastric vessels. One case was in a 52 years old woman. The patient was preoperatively diagnosed with a nonsymptomatic cystadenoma, which measured 7 cm in diameter at the tail of pancreas. The procedure used was a 70% distal pancreatectomy, with preservation of the spleen, including the splenic vessels. Three 10 mm ports, one 15mm port and one linear stapler (EndoGIA60(R)) were used for the procedure. A 3 cm incision, extending 15 mm to the trocar site, was used for the extraction of the specimen. The total operative time was 435 minutes. The patient was discharged on the 8th postoperative day with no problems. The other case was in a 61 years old woman. The patient was preoperatively diagnosed with a symptomatic cystadenoma, which measured 3 cm in size at the body of the pancreas. The procedure used was an 85% distal pancreatectomy, employed the same method as the previous case, with the exception that an EndoGIA30(R) was used for the resection of pancreas in place of the EndoGIA60(R). The total operative time was 400 minutes. The patient was discharged on 9th postoperatvie day, with no problems. There was no morbidity and mortality during hospitalization. A laparoscopic spleen splenic vessels, could be an alternative treatment in selective preserving distal pancreatectomy with the conservation of the patients with benign pancreatic neoplasms.
Subject(s)
Female , Humans , Middle Aged , Cystadenoma , Hospitalization , Laparoscopy , Mortality , Operative Time , Pancreas , Pancreatectomy , Pancreatic Neoplasms , Spleen , Splenic Artery , Surgical Instruments , VeinsABSTRACT
BACKGROUND: Intraductal papillary mucinous tumor (IPMT) of the pancreas is a rare tumor arising in the main pancreatic duct or its subbranches. It is characterized by a diffusely or focally dilated main pancreatic duct filled with mucus and a mucus secretion through a patulous duodenal papilla. METHODS: The clinicopathologic characteristics of eight IPMT cases which were resected surgically from January 1994 to August 1998 at Seoul National University Hospital were reviewed to consider the optimal surgical treatment. RESULTS: The range of ages was from 49 to 70 years with a mean age of 59.3. Five were men and three were women. The prominent symptom was upper abdominal pain. Seven patients had been treated for pancreatitis before. Tumor markers didn't correlate with the pathologic status. In all the cases, a dilated pancreatic duct with secretion of mucin was found in the radiologic studies. Four lesions were located in the uncinate process, 3 in the body, and 1 diffusely. One total pancreatectomy, 1 Whipple's procedure, 3 pylorus-preserving pancreatoduodenectomies, 1 duodenum-preserving resection of the head of the pancreas, and 2 subtotal pancreatectomies were performed. Three lesions were malignant, another three were borderline malignant, and the remaining two were benign. Three were multiple lesions. Lesions for which the main pancreatic duct was dilated more than 0.5 cm, lesions greater than 2.5 cm, lesions with a mural nodule greater than 1.0 cm, or type 1, 2, 3 lesions were borderline malignant or malignant. There was no lymphatic metastasis. After a follow-up duration from 1 month to 56months, all patients are alive at the time of study and have experienced no locoregional recurrence or distant metastasis. CONCLUSIONS: In the radiologic studies, an IPMT should be considered in a multilobulating cystic lesion with the dilated main pancreatic duct. The lesions are variable from benign to malignant and often spread intraductally. When the lesion seems to be malignant, an aggressive resection is recommended.