Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Hepato-Biliary-Pancreatic Sciences
Published in: Journal of Hepato-Biliary-Pancreatic Sciences 6/2010

01-11-2010 | Topics

Parenchyma-sparing resections for pancreatic neoplasms

Authors: Stefano Crippa, Letizia Boninsegna, Stefano Partelli, Massimo Falconi

Published in: Journal of Hepato-Biliary-Pancreatic Sciences | Issue 6/2010

Login to get access

Abstract

Background/purpose

In recent years there has been an increase in the indications for pancreatic resection of benign or low-grade malignant lesions, especially in young patients with long life expectancy. In this setting, patients may benefit from parenchyma-sparing resections in order to decrease the risk of development of exocrine/endocrine insufficiency.

Methods

A review of the literature and authors experience was undertaken.

Results

Parenchyma-sparing resections of the pancreas including enucleation, middle pancreatectomy (MP) and middle-preserving pancreatectomy are described. Short and long-term outcomes after surgery are analyzed with special regard to postoperative morbidity/mortality, and oncological and functional long-term results.

Conclusions

Parenchyma-sparing resections are safe and effective procedures for treatment of benign and low-grade malignant neoplasms. Despite a significant postoperative morbidity they are associated with good long-term functional and oncological results. Enucleation should preferentially be performed laparoscopically whenever possible.
Literature
1.
Bassi C, Falconi M, Salvia R, Mascetta G, Molinari E, Pederzoli P. Management of complications after pancreaticoduodenectomy in a high volume centre: results on 150 consecutive patients. Dig Surg. 2001;18:453–7.CrossRefPubMed
2.
Balcom JH 4th, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg. 2001;136:391–8.CrossRefPubMed
3.
Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997;226:248–57.CrossRefPubMed
4.
Megibow AJ, Lombardo FP, Guarise A, Carbognin G, Scholes J, Macari NM, et al. Cystic masses: cross-sectional imaging observations and serial follow-up. Abdom Imaging. 2001;26:640–7.CrossRefPubMed
5.
Plockinger U, Wiedenmann B. Neuroendocrine tumors of the gastro-entero-pancreatic system: the role of early diagnosis, genetic testing and preventive surgery. Dig Dis. 2002;20:49–60.CrossRefPubMed
6.
Falconi M, Mantovani W, Crippa S, Mascetta G, Salvia R, Pederzoli P. Pancreatic insufficiency after different resections for benign tumours. Br J Surg. 2008;95:85–91.CrossRefPubMed
7.
Kahl S, Malfertheiner P. Exocrine and endocrine pancreatic insufficiency after pancreatic surgery. Best Pract Res Clin Gastroenterol. 2004;18:947–55.PubMed
8.
Slezak LA, Andersen DK. Pancreatic resection: effects on glucose metabolism. World J Surg. 2001;25:452–60.CrossRefPubMed
9.
Aranha GV, Shoup M. Nonstandard pancreatic resections for unusual lesions. Am J Surg. 2005;189:223–8.CrossRefPubMed
10.
Crippa S, Bassi C, Salvia R, Falconi M, Butturini G, Pederzoli P. Enucleation of pancreatic neoplasms. Br J Surg. 2007;94:1254–9.CrossRefPubMed
11.
Park BJ, Alexander HR, Libutti SK, Huang J, Royality D, Skarulis MC, et al. Operative management of islet-cell tumors arising in the head of the pancreas. Surgery. 1998;124:1056–61.CrossRefPubMed
12.
Yeo CJ, Wang BH, Anthone GJ, Cameron JL. Surgical experience with pancreatic islet-cell tumors. Arch Surg. 1993;128:1143–8.PubMed
13.
Pyke CM, van Heerden JA, Colby TV, Sarr MG, Weaver AL. The spectrum of serous cystadenoma of the pancreas. Clinical, pathologic, and surgical aspects. Ann Surg. 1992;215:132–9.CrossRefPubMed
14.
Talamini MA, Moesinger R, Yeo CJ, Poulose B, Hruban RH, Cameron JL, et al. Cystadenomas of the pancreas. Is enucleation an adequate operation? Ann Surg. 1998;227:896–903.CrossRefPubMed
15.
Le Borgne J, de Calan L, Partensky C. Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases. French Surgical Association. Ann Surg. 1999;230:152–61.CrossRefPubMed
16.
Madura JA, Yum MN, Lehman GA, Sherman S, Schmidt CM. Mucin secreting cystic lesions of the pancreas: treatment by enucleation. Am Surg. 2004;70:106–12.PubMed
17.
Kiely JM, Nakeeb A, Komorowski RA, Wilson SD, Pitt HA. Cystic pancreatic neoplasms: enucleate or resect? J Gastrointest Surg. 2003;7:890–7.CrossRefPubMed
18.
Madan AK, Weldon CB, Long WP, Johnson D, Raafat A. Solid and papillary epithelial neoplasm of the pancreas. J Surg Oncol. 2004;15:193–8.CrossRef
19.
Sciaudone G, Perniceni T, Levy P, Bougaran J, Gayet B. Enucleation of intraductal papillary-mucinous tumor of the head of the pancreas. Gastroenterol Clin Biol. 2000;24:17–20.
20.
Casadei R, Minni F, Selva S, Marrano N, Marrano D. Cystic lymphangioma of the pancreas: anatomoclinical, diagnostic and therapeutic considerations regarding three personal observations and review of the literature. Hepatogastroenterology. 2003;50:1681–6.PubMed
21.
Fernàndez-Cruz L, Cesar-Borges G. Laparoscopic strategies for resection of insulinomas. J Gastrointest Surg. 2006;10:752–60.CrossRefPubMed
22.
Fernàndez-Cruz L, Cosa R, Blanco L, Levi S, Lopez-Boardo MA, Navarro S. Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J Gastrointest Surg. 2007;11:1607–21.CrossRefPubMed
23.
Arbuckle JD, Kekis PB, Lim A, Jackson JE, Todd JF, Lynn J, et al. Laparoscopic management of insulinomas. Br J Surg. 2009;96:185–90.CrossRefPubMed
24.
Luo YL, Liu R, Hu MG, Mu YM, An LC, Huang ZQ. Laparoscopic surgery for pancreatic insulinomas: a single-institution experience of 29 cases. J Gastrointest Surg. 2009;13:945–50.CrossRefPubMed
25.
Guillemin P, Bessot M. Pancreatite chronique calcifiante chez un tuberculeux renal: pancreatojejunostomie sion une technique originale. Mem Acad Chir. 1957;83:869–71.PubMed
26.
Dagradi A, Serio G. Pancreatectomia intermedia. In: Enciclopedia Medica Italiana. Pancreas, vol 11. Florence: Scientifiche; 1984. p. 850–1.
27.
Roggin KK, Rudloff U, Blumgart LH, Brennan MF. Central pancreatectomy revisited. J Gastrointest Surg. 2006;10:804–12.CrossRefPubMed
28.
Crippa S, Bassi C, Warshaw AL, Falconi M, Partelli S, Thayer SP, et al. Middle pancreatectomy. Indications, short- and long-term operative outcomes. Ann Surg. 2007;246:69–76.CrossRefPubMed
29.
Muller MW, Friess H, Kleeff J, Hinz U, Wente MN, Paramythiotis D, et al. Middle segmental pancreatic resection. An option to treat benign pancreatic body lesions. Ann Surg. 2006;244:909–20.CrossRefPubMed
30.
Iacono C, Bortolasi L, Facci E, Nifosì F, Pachera S, Ruzzenente A, et al. The Dagradi–Serio–Iacono operation central pancreatectomy. J Gastrointest Surg. 2007;11:364–70.CrossRefPubMed
31.
Warshaw AL, Rattner DW, Fernandez del Castillo C, Z’graggen K. Middle segment pancreatectomy. A novel technique for conserving pancreatic tissue. Arch Surg. 1998;133:327–30.CrossRefPubMed
32.
Fagniez PL, Kracht M, Rotman N. Limited conservative pancreatectomy for benign tumors: a new technical approach. Br J Surg. 1988;75:719.CrossRefPubMed
33.
Rotman N, Satre B, Fagniez Pl. Medial pancreatectomy for tumors of the neck of the pancreas. Surgery. 1993;113:532–5.PubMed
34.
Iacono C, Bortolasi L, Serio G. Is there a place for central pancreatectomy in pancreatic surgery? J Gastrointest Surg. 1998;2:509–17.CrossRefPubMed
35.
Christein JD, Smoot RL, Farnell MB. Central pancreatectomy: a technique for the resection of pancreatic neck lesions. Arch Surg. 2006;141:293–9.CrossRefPubMed
36.
Sauvanet A, Partensky C, Sastre B, Gigot JF, Fagniez PL, Tuech JJ, et al. Medial pancreatectomy: a multi-institutional retrospective study of 53 patients by the French Pancreas Club. Surgery. 2002;132:836–43.CrossRefPubMed
37.
Efron DT, Lillemoe KD, Cameron JL, Yeo CJ. Central pancreatectomy with pancreaticogastrostomy for benign pancreatic pathology. J Gastrointest Surg. 2004;8:532–8.CrossRefPubMed
38.
Sperti C, Pasquali C, Ferronato A, Pedrazzoli S. Median pancreatectomy for tumors of the neck and body of the pancreas. J Am Coll Surg. 2000;190:711–6.CrossRefPubMed
39.
Balzano G, Zerbi A, Veronesi P, Cristallo M, Di Carlo V. Surgical treatment of benign and borderline neoplasms of the pancreatic body. Dig Surg. 2003;20:506–10.CrossRefPubMed
40.
Orsenigo E, Baccari P, Bussolotti G, Staudacher C. Laparoscopic central pancreatectomy. Am J Surg. 2006;191:549–52.CrossRefPubMed
41.
Rotellar F, Pardo F, Montiel C, Benito A, Regueira FM, Povera I, et al. Totally laparoscopic Roux-en-Y duct-to-mucosa pancreaticojejunostomy after middle pancreatectomy. Ann Surg. 2008;247:938–44.CrossRefPubMed
42.
Partelli S, Boninsegna L, Salvia R, Bassi C, Pederzoli P, Falconi M. Middle-preserving pancreatectomy for multicentric body-sparing lesions of the pancreas. Am J Surg. 2009;198:e49–53.CrossRefPubMed
43.
Reber HA. Middle pancreatectomy: why I rarely do it. J Gastrointest Surg. 2007;11:726–9.CrossRef
44.
Norton JA. Surgery for primary pancreatic neuroendocrine tumors. J Gastrointest Surg. 2006;10:327–31.CrossRefPubMed
45.
de Herder WW, Niederle B, Scoazec JY, Pauwels S, Kloppel G, Falconi M, et al. Well-differentiated pancreatic tumor/carcinoma: insulinoma. Neuroendocrinology. 2006;84:183–8.CrossRefPubMed
46.
Falconi M, Plockinger U, Kwekkeboom DJ, Manfredi R, Korner M, Kvols L, et al. Well-differentiated pancreatic nonfunctioning tumors/carcinoma. Neuroendocrinology. 2006;84:196–211.CrossRefPubMed
47.
Howard JM, Hess W. History of the pancreas: mystery of a hidden organ. New York: Kluwer Academic/Plenum Publisher; 2002.
48.
Norton JA, Fraker DL, Alexander HR, Venzon DJ, Doppman JL, Serrano J, et al. Surgery to cure the Zollinger–Ellison syndrome. N Engl J Med. 1999;341:635–44.CrossRefPubMed
49.
Hiramoto JS, Feldstein VA, Laberge JM, Norton JA. Intraoperative ultrasound and preoperative localization detects all occult insulinomas. Arch Surg. 2001;136:1020–5.CrossRefPubMed
50.
Boninsegna L, Falconi M, Zerbi A, Crippa S, Capitanio V, Bettini R, et al. Are atypical resections of the pancreas safe and effective in treating small pancreatic endocrine tumors? JOP. 2008;9(6 Suppl):779–80.
51.
Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasm of the pancreas. Pancreatology. 2006;6:17–32.CrossRefPubMed
52.
Rodriguez JR, Salvia R, Crippa S, Warshaw AL, Bassi C, Falconi M, et al. Branch-duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection. Gastroenterology. 2007;133:72–9.CrossRefPubMed
53.
Crippa S, Fernandez-del Castillo C. Management of intraductal papillary mucinous neoplasms. Curr Gastroenterol Rep. 2008;10:136–43.CrossRefPubMed
Metadata
Title
Parenchyma-sparing resections for pancreatic neoplasms
Authors
Stefano Crippa
Letizia Boninsegna
Stefano Partelli
Massimo Falconi
Publication date
01-11-2010
Publisher
Springer Japan
Published in
Journal of Hepato-Biliary-Pancreatic Sciences / Issue 6/2010
Print ISSN: 1868-6974
Electronic ISSN: 1868-6982
DOI
https://doi.org/10.1007/s00534-009-0224-1

Other articles of this Issue 6/2010

Journal of Hepato-Biliary-Pancreatic Sciences 6/2010 Go to the issue

Topics

For which type of chronic pancreatitis is the “Hamburg procedure” indicated?

Topics

Pancreatic head resection with segmental duodenectomy for pancreatic neoplasms

Topics

Beger’s operation and the Berne modification: origin and current results

Topics

Appraisal of the Imaizumi modification of the Beger procedure: the TWMU experience

Original article

Muromonab-CD3 therapy for refractory rejections after liver transplantation: a single-center experience during two decades in Japan

Topics

Endoscopic treatment for chronic pancreatitis: indications, technique, results