Clinical observation of splenectomy with distal pancreatectomy during cytoreductive surgery in epithelial ovarian cancer / 复旦学报（医学版）

Objective To evaluate the safety and efficacy of splenectomy with distal pancreatectomy during cytoreductive surgery in epithelial ovarian cancer(EOC).Methods A total of 17 patients from Zhongshan Hospital,Fudan University and the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)received splenectomy with distal pancreatectomy during cytoreductive surgery in EOC were recruited.Their clinicopathological characteristics,postoperative complications and survival situation were retrospective analyzed.Results Of the 17 patients,there were 13 primary cases and 4 recurrent cases.Eleven cases(64.7%)had preoperative imaging finding with metastatic lesions in the splenic hilum,among whom 6 cases had distal pancreas metastasis during the operation.The drainage was placed in the splenic fossa for the measurement of amylase levels in drain fluid and was removed after 8(3-12)days.There were 4 patients had postoperative pancreatic fistula(POPF)of grade A,3 patients had POPF of grade B and no POPF of grade C occurred.The 2 patients with POPF of grade B improved after percutaneous drainage,and the rest recovered with somatostatin,antibiotic drugs and medicines without perioperative mortality.The interval between surgery to chemotherapy was 17.5(13-37)days.The median follow-up time was 14(4-64)months and the median progression-free survival was 10(5-32)months.Conclusion Splenectomy with distal pancreatectomy as part of cytoreduction surgery in EOC is needed for optimal resection,and the complication of pancreatic fistula could be managed conservatively.

Preliminary Study on Prognostic Factors of New-onset Diabetes Mellitus After Distal Pancreatectomy for Pancreatic Cystic Tumor / 中国微创外科杂志

Objective To explore the prognostic factors of new-onset diabetes mellitus(NODM)in patients with pancreatic cystic tumor after distal pancreatectomy(DP).Methods Between January 2010 and December 2019,92 patients with cystic pancreatic tumors in our hospital underwent laparoscopic DP.According to the inclusion and exclusion criteria,a total of 74 cases were included and divided into NODM group or normal glucose metabolism group based on whether postoperative NODM occurred.A univariate analysis was used to evaluate the prognostic factors of laparoscopic DP for pancreatic cystic tumors.P<0.05 was considered statistically significant,OR>4 was considered as a potential prognostic factor of clinical significance for NODM.Results NODM was diagnosed in26 cases(35.1%),with a median diagnosis time of 9 months(range,3-56 months)after surgery.Univariate analysis showed that transecting pancreas in the neck(OR = 11.000,P = 0.000),BMI≥25.0(OR = 4.333,P = 0.007),and family history of diabetes mellitus(OR =5.000,P =0.004)were prognostic factors of postoperative NODM.Conclusions When performing DP for pancreatic cystic tumors,it is advisable to preserve as much pancreatic tissue as possible and avoid cutting off the pancreas in the neck.Precise postoperative strategy of glucose metabolism surveillance for patients with BMI≥25.0 and family history of diabetes mellitus should be promoted.

Quiste hidatídico primario de páncreas: reporte de caso

Introducción. El quiste hidatídico puede localizarse en cualquier órgano del cuerpo. El quiste hidatídico en el páncreas (QHP)se presenta con una prevalencia menor a 1%, la localización más frecuente es la cabeza en 61% a 69%, en el cuerpo y cola en 31% a 39%. No es fácil diferenciar el quiste hidatídico pancreático de otros tumores quísticos del páncreas, por lo que esta patología debe tenerse en cuenta en el diagnóstico diferencial de lesiones quísticas pancreáticas. Caso Clínico. Paciente femenino de 66 años quien desde el año 2016 se encontraba en control por una tumoración quística de la cola pancreática de 1,7 cm, diagnosticada en forma incidental. La paciente cursó asintomática y se controló en forma anual. El año 2021 la lesión alcanzó un tamaño de 4,7 cm. En este contexto se decide la resección quirúrgica por vía laparoscópica. Se resecó una pieza quirúrgica de 8 cm de longitud que incluye la cola del páncreas y el quiste. La histología describe la membrana prolígera y múltiples escólex viables. Conclusión. La localización primaria en la cola del páncreas de un quiste hidatídico confunde el diagnóstico con un tumor quístico mucinoso. El tratamiento quirúrgico actual en los quistes distales debería ser la resección laparoscópica.

Introduction. The hydatid cyst can be located in any organ of the body. The hydatid cyst in the pancreas occurs with a prevalence of less than 1%, the most frequent location is the head in 61% to 69%, the body and tail in 31% to 39%. It is not easy to differentiate the pancreatic hydatid cyst from other cystic tumors of the pancreas, so this pathology must be taken into account in the differential diagnosis of pancreatic cystic lesions. Clinical Case. The present report discusses a 66-year-old female patient who had been in control since 2016 for a 1.7 cm cystic tumor of the pancreatic tail. The patient was asymptomatic and was controlled annually. In 2021, the lesion reached a size of 4.7 cm. In this context, laparoscopic surgical resection was decided. An 8 cm long surgical specimen was resected, including the tail of the pancreas and the cyst. Histology describes prolific membrane and multiple viable scolexes. Conclusion. The primary location in the tail of the pancreas of a hydatid cyst confuses the diagnosis with a mucinous cystic tumor. The current surgical treatment for distal cysts should be laparoscopic resection.

Laparoscopic subtotal distal pancreatectomy using the arterial first approach in patients who underwent post-neoadjuvant chemotherapy for pancreatic neck-body cancer / 中华肝胆外科杂志

Objective:To study the safety and efficacy of laparoscopic subtotal distal pancreatectomy using the arterial first approach in treatment of patients with pancreatic neck-body cancer after neoadjuvant chemotherapy.Methods:The clinical data of patients who underwent laparoscopic subtotal distal pancreatectomy after neoadjuvant chemotherapy at the Department of Pancreatic Surgery, Hunan Provincial People's Hospital from January 2019 to June 2021 were analyzed retrospectively. Seven patients were included in this study. There were 3 males and 4 females, aged 55(46, 67) years old. The clinical data analysed included chemotherapy, preoperative, intraoperative, postoperative and follow-up data. Follow up was done by outpatient visits, or contact using wechat or telephone.Results:Five borderline staged patients were treated with the AG chemotherapy regimen (gemcitabine+ albumin-bound paclitaxel), and two patients with locally advanced stage were treated with the mFOLFIRINOX chemotherapy regimen (oxaliplatin+ irinotecan+ calcium folate+ fluorouracil). All the 7 patients underwent portal vein/superior mesenteric vein resection and reconstruction using the superior mesenteric artery priority approach. The operation time was 400(350, 440) min, and the intraoperative blood loss was 300(150, 400) ml. Postoperative complications occurred in 2 patients with grade B pancreatic fistula and refractory ascites in 1 patient each. The postoperative hospital stay was 11(10, 14) days. All 7 patients underwent R 0 resection. During a follow-up period of 9 to 33 months, 5 patients were still alive without tumor, 1 patient survived with tumor, and 1 patient had died of recurrence. Conclusion:In selected cases, laparoscopic subtotal distal pancreatectomy for pancreatic neck-body cancer after neoadjuvant chemotherapy was safe and feasible.

Three-dimensional visualization technology in the use of laparoscopic spleen-preserving distal pancreatectomy / 中华普通外科杂志

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.

Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions / 医学前沿

Postoperative pancreatic fistula (POPF) is the most common and critical complication after pancreatic body and tail resection. How to effectively reduce the occurrence of pancreatic fistula and conduct timely treatment thereafter is an urgent clinical issue to be solved. Recent research standardized the definition of pancreatic fistula and stressed the correlation between POPF classification and patient prognosis. According to the literature, identification of the risk factors for pancreatic fistula contributed to lowering the rate of the complication. Appropriate management of the pancreatic stump and perioperative treatment are of great significance to reduce the rate of POPF in clinical practice. After the occurrence of POPF, the treatment of choice should be determined according to the classification of the pancreatic fistula. However, despite the progress and promising treatment approaches, POPF remains to be a clinical issue that warrants further studies in the future.

Spleen Preservation in Laparoscopic Distal Pancreatectomy for Solid Pseudopapillary Neoplasm is Oncologically Safe

PURPOSE: Laparoscopic distal pancreatectomy (LDP) has been widely performed for solid pseudopapillary neoplasm (SPN) involving the body or tail of the pancreas. However, it has not been established whether spleen preservation in LDP is oncologically safe for the treatment of SPN with malignant potential. In this study, we compared the short- and long-term outcomes between patients with SPN who underwent laparoscopic spleen-preserving distal pancreatectomy (LSPDP) vs laparoscopic distal pancreatectomy with splenectomy (LDPS). METHODS: We retrospectively reviewed the medical records of 46 patients with SPN who underwent LDP between January 2005 and November 2016. Patients were divided into 2 groups according to spleen preservation: the LSPDP group (n=32) and the LDPS group (n=14). Clinicopathologic characteristics and perioperative outcomes were compared between groups. RESULTS: There were no significant differences in pathologic variables, including tumor size, tumor location, node status, angiolymphatic invasion, or perineural invasion between groups. Median operating time was significantly longer in the LSPDP group vs the LDPS group (243 vs 172 minutes; p=0.006). Estimated intraoperative blood loss was also significantly greater in the LSPDP group (310 vs 167 ml; p=0.063). There were no significant differences in incidence of postoperative complications (≥ Clavien-Dindo class IIIa) or pancreatic fistula between groups. After a median follow-up of 35 months (range, 3S153 months), there was no recurrence or disease-specific mortality in either group. CONCLUSION: The results show that LSPDP is an oncologically safe procedure for SPN involving the body or tail of the pancreas.

Efficacy comparison between robotic and laparoscopic distal pancreatectomy in treatment of pancreatic body and tail cancer / 肿瘤研究与临床

Objective@#To compare the short-term efficacy of robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP) in treatment of pancreatic body and tail cancer, and to explore the feasibility of RDP.@*Methods@#The clinical data of 11 patients who received RDP and 26 patients who received LDP from January 2014 to May 2018 in the First Hospital of Shanxi Medical University were retrospectively analyzed. The operation indexes and the hospitalized cost of both groups were compared.@*Results@#There were no significant differences in spleen-preserving rate, postoperative hospital stay, postoperative pain, intraoperative or postoperative blood transfusion, postoperative bleeding and pancreatic fistula between the two groups (all P > 0.05), but the amount of intraoperative bleeding in RDP group was less than that in LDP group, and the difference was statistically significant [(144±51) vs. (199±65) ml, t = -2.530, P = 0.016]. Compared with LDP group, the total hospitalization cost and operation cost of RDP group was increased [(75 000±14 000) yuan vs. (107 000±12 000) yuan; (21 000±9 000) yuan vs. (39 000±16 000) yuan; both P < 0.01].@*Conclusion@#Both RDP and LDP are safe and feasible. LDP has the advantages of relative low cost and wide range of operations. RDP has obvious advantages in controlling intraoperative bleeding, but the high cost limits its further clinical promotion.

Prevention value of four treatments of pancreatic stump for pancreatic fistula after distal pancreatectomy: a Meta-analysis / 中华消化外科杂志

Objective To systematically evaluate the clinical effects of four treatments of pancreatic stump including stapler closure,hand-sutured closure,stapler with hand-sutured closure,and manual anastomosis on the prevention of postoperative pancreatic fistula after distal pancreatectomy.Methods Databases including PubMed,Embase,the Cochrane Library,CBM,CNKI,and VANFUN were searched for from January 1979 to January 2019 with the key words including "distal pancreatectomy,left pancreatectomy,distal pancreatic resection,left pancreatic resection,pancreatic fistula,fistula,leak,stapler,suture,anastomosis,胰腺远端切除 术,胰体尾切除术,闭合器,手工缝合,吻合,胰瘘”.Patients undergoing dissection of distal pancreas with Endo-GIA stapler were allocated into stapler group,patients undergoing hand-sutured closure of pancreatic stump after dissection of distal prancreas with electrotome or ultrasonic scalpel were allocated into hand-sutured closure group,patients undergoing dissection of distal pancreas with Endo-GIA stapler and hand-sutured closure of pancreatic stump were allocated into stapler with hand-sutured closure group,patients undergoing pancreaticojejunostomy or pancreatogastrostomy after dissection of distal pancreas were allocated into manual anastomosis group,respectively.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.Count data were described as odds ratio (OR) and 95％ confidence interval (95％ CI).The heterogeneity of the studies included was analyzed using the I2 test.Funnel plot was used to test potential publication bias if the studies included ≥ 5,and no test was needed if the studies included ＜5.Results (1) Document retrieval:a total of 10 available prospective studies were included.There were 1 363 patients,including 565 in the stapler group,484 in the hand-sutured closure group,182 in the stapler with hand-sutured closure group,and 132 in the manual anastomosis group.(2) Results of Meta-analysis.① There was no statistically significant difference in postoperative fistula after distal pancreatectomy between the stapler group and the handsutured closure group (OR =0.75,95％CI:0.45-1.25,P＞0.05).Further study showed that there was no statistically significant difference in the incidence of grade B and C postoperative fistula between the two groups (OR=0.45,95％CI:0.14-1.52,P＞0.05).The left-right asymmetry was presented in the funnel plot based on the 8 studies,suggesting that publication bias may exsited.② There was no statistically significant difference in postoperative fistula after distal pancreatectomy between the stapler group and the stapler with hand-sutured closure group (OR =0.96,95％ CI:0.48-1.91,P ＞ 0.05).③ There was no statistically significant difference in postoperative fistula after distal pancreatectomy between the stapler with hand-sutured closure group and manual anastomosis group (OR =0.80,95％ CI:0.49-1.32,P＞ 0.05).④ There was no statistically significant difference in postoperative fistula after distal pancreatectomy between the manual anastomosis group and the stapler group (OR=0.73,95％CI:0.39-1.34,P＞0.05).Further study showed that there was no statistically significant difference in the incidence of grade B and C postoperative fistula between the two groups (OR =0.60,95％CI:0.21-1.68,P＞0.05).The bilateral symmetry was presented in the funnel plot based on the 5 studies,suggesting that publication bias had little influence on results of Meta-analysis.⑤ There was no statistically significant difference in postoperative fistula after distal pancreatectomy between the manual anastomosis group and the handsutured closure group (OR=0.24,95％CI:0.08-0.74,P＜0.05).The bilateral symmetry was presented in the funnel plot,suggesting that publication bias had little influence on results of Meta-analysis.Conclusions Compared with hand-sutured closure,pancreaticojejunostomy or pancreatogastrostomy after distal pancreatectomy can help to reduce the incidence of postoperative pancreatic fistula.However,there was equivalent prevention value of stapler,hand-sutured closure,and stapler with hand-sutured closure for postoperative fistula after distal pancreatectomy.The manual anastomosis group has equivalent prevention value with stapler group.

Distal pancreatectomy with celiac axis resection(DP-CAR) for pancreatic cancer: An analysis of 40 cases / 中国实用外科杂志

OBJECTIVE: To assess the safety and efficacy of distal pancreatectomy with celiac axis resection(DP-CAR).METHODS: The clinical and pathological data of 40 patients with pancreatic cancer who underwent DP-CAR at the Changhai Hospital affiliated to the Naval Military Medical University from January 2012 to December 2016 were analyzed retrospectively.The postoperative incidence of complications,mortality and overall survival were analyzed respectively.RESULTS: The incidence of complication in the 40 patients(Clavien-Dindo score≥2) was 32.5%(13 cases)including 1 case(2.5%) died of liver failure in 90 days after surgery due to hepatic ischemia,6 cases(15.0%) of grade B or above pancreatic fistula,7 cases(17.5%) of gastric emptying disorder,6 cases(15,0%) of severe abdominal infection,4 cases(10.0%) of chyle leakage,and 4 cases(10%) of postpancreatectomy hemorrhage(PPH).Total median survival was19.1 months(IQR 8.9,30.8 months),one-year,three-year and five-year survival rate:62.5%,17.5% and 5.0%.Patients of T4(median survival:T4 14.2 months vs.T1-3 24.1 months,P=0.0225),lymph node metastasis of N1-2(median survival:N1-2 8.8 months vs.NO 23.2 months,P=0.00967) had a worse median survival time.CONCLUSION: In high-selective patients with pancreatic body/tail cancer,the morbidity,mortality and median survival after DP-CAR surgery are acceptable,and patients with T4 and regional lymph nodes enlargement in preoperative imaging evaluation should be performed neoadjuvant therapy,and then be re-evaluated before DP-CAR.

Research progress of distal pancreatectomy with en bloc celiac axis resection / 中华消化外科杂志

Carcinoma of pancreatic body and tail is a high invasive disease with a low resectability rate.It was once believed that celiac axis infiltration usually contraindicated resection.Distal pancreatectomy with en bloc celiac axis resection (DP-CAR) is described as a new treatment method of this disease.In recent years,more and more literatures have reported this operation,but they were case reports or small sample retrospective study,the results of which differed according to the different treatments and perioperative managements in different centers.The advantages and disadvantages of DP-CAR are still controversial.Research progress of DP-CAR is reviewed in this article.

Laparoscopic treatment of space occupying lesions in pancreatic body and tail: a report of 65 patients / 中华肝胆外科杂志

Objective To study the surgical treatment strategies,techniques and results of laparoscopic surgery for space occupying lesions in pancreatic body and tail.Methods To retrospectively analyze the clinical data of 65 patients with space occupying lesions in pancreatic body and tail.These patients were consecutively treated in Department of Minimally Invasive Surgery,the First Affiliated Hospital of Zhengzhou University from January 2010 to November 2017.Results All operations on the 65 patients were performed laparoscopically.The operations included laparoscopic distal pancreatectomy with splenectomy (n =22),spleen preserving laparoscopic distal pancreatectomy (n =43,with Kimura's method,n =38;and Warshaw's method,n =5).The mean size of the lesions was 5.5 cm (range 1.0 ～ 11.2 cm).The mean intraoperative blood loss was 120 ml (range 30～350 ml).The mean operation time was 230 min (range 160～310 min).Complications developed in 11 patients (16.9％).There were no tumour recurrence on follow-up which ranged from 1 to 81 months.Conclusions For patients with space occupying lesions in pancreatic body and tail,surgical strategies should be planned according to the site of the lesion and its relation to the blood vessels of the spleen.With good surgical techniques,laparoscopic treatment of lesions in pancreatic body and tail can be carried out safely,with a low complication rate and with an increased spleen preservation rate.

Efficacy comparison between robotic and laparoscopic distal pancreatectomy in treatment of pancreatic body and tail cancer / 肿瘤研究与临床

Objective To compare the short-term efficacy of robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP) in treatment of pancreatic body and tail cancer, and to explore the feasibility of RDP. Methods The clinical data of 11 patients who received RDP and 26 patients who received LDP from January 2014 to May 2018 in the First Hospital of Shanxi Medical University were retrospectively analyzed. The operation indexes and the hospitalized cost of both groups were compared. Results There were no significant differences in spleen-preserving rate, postoperative hospital stay, postoperative pain, intraoperative or postoperative blood transfusion, postoperative bleeding and pancreatic fistula between the two groups (all P>0.05), but the amount of intraoperative bleeding in RDP group was less than that in LDP group, and the difference was statistically significant [(144±51) vs. (199±65) ml, t= -2.530, P= 0.016]. Compared with LDP group, the total hospitalization cost and operation cost of RDP group was increased [ (75000±14000) yuan vs. (107000±12000) yuan;(21000±9000) yuan vs. (39000±16000) yuan;both P<0.01]. Conclusion Both RDP and LDP are safe and feasible. LDP has the advantages of relative low cost and wide range of operations. RDP has obvious advantages in controlling intraoperative bleeding, but the high cost limits its further clinical promotion.

Clinical value of uncinate process resection combined with portal-superior mesenteric vein resection and end-to-end anastomosis in distal pancreatectomy / 中华消化外科杂志

Objective To explore the clinical value of uncinate process resection combined with portalsuperior mesenteric vein resection and end-to-end anastomosis in distal pancreatectomy.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 11 patients who underwent distal pancreatectomy combined with portal-superior mesenteric vein resection and end-to-end anastomosis in the Peking University Cancer Hospital (8 patients) and Jilin Guowen Hospital (3 patients) between January 2014 to April 2018 were collected.During the vascular reconstruction,uncinate process of the pancreas was first resected for reducing anastomotic tension,and then end-to-end anastomosis was done after portal-superior mesenteric vein resection.Observation indicators:(1) intraoperative situations;(2) postoperative recovery situations;(3) postoperative pathological examination situations;(4) follow-up and survival situations.Follow-up using outpatient examination and imaging examination was performed to detect patients' postoperative survival,tumor recurrence and metastasis and postoperative venous anastomotic patency up to May 2018.Measurement data with normal distribution were represented as x±s.Measurement data with skewed distribution were described as M (range).The non-recurrence and non-metastasis survival curve,overall survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method.Results (1) Intraoperative situations:11 patients received uncinate process resection of the pancreas,and successfully underwent distal pancreatectomy combined with portal-superior mesenteric vein resection and end-to-end anastomosis.Eight patients underwent distal pancreatectomy + Appleby combined with celiac axis resection due to pancreatic tumor involving common hepatic artery,including 2 undergoing combined total gastrectomy due to gastric ischemia;2 patients underwent distal pancreatectomy;1 patient underwent distal pancreatectomy + distal gastrectomy due to blood supply obstacle of distal stomach.Operation time and volume of intraoperative blood loss of 11 patients were (5.8± 1.1) hours and 800 mL (range,200-2 500 mL).(2) Postoperative recovery situations:there was no grade C of pancreatic fistula of 11 patients.Four patients had grade B of pancreatic fistula,including 2 were cured by drainage-tube indwelling of pancreatic wound ＞ 3 weeks,1 was cured by continous washing due to pancreatic fistula combined with infection,and 1 was cured by the second abdominal puncture drainage due to pancreatic fistula with fever;1 of 4 patients was combined with grade C of delayed gastric emptying and cured by conservative treatment,and other 3 patients didn't occur postoperative complications.Of 5 patients diagnosed as biochemical fistula,1 had esophagus-jejunum anastomotic leakage,and 1 had changes of hepatic ischemia in S2,S3 and S4b segments by CT examination and recovered normal liver function at 2 weeks postoperatively,with long-term hepatatrophia in S2 and S3 segments.There was no postoperative death and reoperation in 11 patients.Duration of postoperative hospital stay of 11 patients was (22± 5) days.(3) Postoperative pathological examination results:tumors of 11 patients were located in neck and body of the pancreas,with a maximum diameter of (4.8± 1.7)cm.Among 11 patients,10 were confirmed with moderate-or low-differentiated ductal adenocarcinoma and 1 with anaplastic carcinoma.The length of portal-superior mesenteric vein resection of 11 patients was (2.6± 0.8) cm.Seven of 11 patients occurred different degrees of tumor infiltration in the portal-superior mesenteric vein,and other 4 patients occurred inflammatory adhesion,without tumor infiltration.(4) Follow-up and survival situations:11 patients were followed up for 3.0-37.6 months,with a median time of 15.7 months.During the follow-up,8 patients died of tumor recurrence and /or metastasis,and 3 survived;the non-recurrence and non-metastais survival time and overall survival time were respectively 9.0 months (range,3.0-37.6 months) and 24.6 months (range,3.0-37.6 months).One patient was complicated with anastomotic stenosis and surrounding varices of portal-superior mesenteric vein by postoperative half-year reexamination,anastomotic vein anomalies and venous thrombosis were not found in other patients before local tumor recurrence and / or death.Conclusion The combined uncinate process resection of the pancreas cannot increase the risk of postoperative pancreatic fistula,and it could effectively reduce the anastomotic tension in the distal pancreatectomy combined with portal-superior mesenteric vein resection and reconstruction,meanwhile,it can also achieve end-to-end anastomosis after longer vein resection.

Robot-assisted distal pancreatectomy: a study on 61 patients / 中华肝胆外科杂志

Objective To study the effect of robot-assisted distal pancreatectomy.Methods 63 patients who were originally scheduled for robot-assisted distal pancreatectomy were vetrospectively analyzed from July 2013 to June 2017 in Changhai Hospital.Results The operations were successfully carried out in 61 patients.One patient was converted to open surgery because of extensive adhesions,and another patient underwent local excision of a pancreatic tumor.17 patients underwent robot-assisted spleen-preserving distal pancreatectomy,and 44 patients robot-assisted distal splenopancreatectomy.The mean operative time was 164.1 minutes.The intraoperative blood loss was 153.7 ml.Only 1 patient received 400 ml.of blood transfusion.The rate of postoperative pancreatic fistula was 45.9％.The rates of biochemical fistula and level B fistula were 37.7％ and 8.2％,respectively.No level C fistula was observed.Conclusion Robot-assisted distal pancreatectomywas an efficacious and safe technique with its unique advantages in spleen-preserving operations.

The current research status of pancreas surgery complicated with chylous fistula / 中华肝胆外科杂志

Chylous fistula is a common complication after pancreatectomy,which can cause poor prognosis of patients.The special anatomic position of the pancreas,the invasive capacity of the disease as well as the improper postoperative diet are all the critical factors leading to the occurrence of chylous fistula.International Study Group of Pancreatic Surgery (ISGPS) recently published the definition and classification of the pancreatic postoperative chylous fistula,providing a guideline for its treatment and prevention.However,surgeons should develop more researches in order to reduce the incidence of postoperative chylous fistula.This paper summarizes the current research status of pancreatic postoperative chylous fistula.

Laparoscopic spleen-preserving distal pancreatectomy in the treatment of pancreatic benign and borderline tumors / 中华肝胆外科杂志

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.

Clinical efficacy of laparoscopic spleen-preserving distal pancreatectomy / 中华消化外科杂志

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.

The clinical efficacy of resection with spleen preservation or containing for benign and borderline tumor in pancreatic tail / 临床外科杂志

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.

Bazo accesorio intrapancreático que imita tumor de cola de páncreas / Intrapancreatic accessory spleen mimicking a tumor of the pancreatic tail

La presencia de bazos accesorios en la cavidad abdominal es relativamente frecuente (10-15% de la población general). De esos, el 1,7 % puede ser de localización intrapancreática. La existencia de un bazo accesorio intrapancreático obliga a hacer el diagnóstico diferencial con tumores sólidos de la cola de páncreas. Presentamos un caso, resuelto mediante pancreatectomia corporocaudal laparoscópica y realizamos una revisión bibliográfica.

Accessory spleens in the abdominal cavity are relatively frequent (10-15% of the general population). Of these, 1.7% may present intrapancreatic localization. An accessory spleen located in the pancreas requires making a differential diagnosis with solid tumors of the tail of the pancreas. We report on a case treated by laparoscopic pancreatectomy.