Laparoscopic Duodenum and Spleen-Preserving Subtotal or Total Pancreatectomy: A Parenchyma-Sparing Strategy for Main Duct Intraductal Papillary Mucinous Neoplasms (with Video).

IF 3.4 2区 医学 Q2 ONCOLOGY
Annals of Surgical Oncology Pub Date : 2024-12-01 Epub Date: 2024-09-23 DOI:10.1245/s10434-024-16244-2
Zheng Li, Yihua Shi, Wenjie Tang, Chen Chen, Wensheng Liu, Qifeng Zhuo, Shunrong Ji, Chenjie Zhou, Xianjun Yu, Xiaowu Xu
{"title":"Laparoscopic Duodenum and Spleen-Preserving Subtotal or Total Pancreatectomy: A Parenchyma-Sparing Strategy for Main Duct Intraductal Papillary Mucinous Neoplasms (with Video).","authors":"Zheng Li, Yihua Shi, Wenjie Tang, Chen Chen, Wensheng Liu, Qifeng Zhuo, Shunrong Ji, Chenjie Zhou, Xianjun Yu, Xiaowu Xu","doi":"10.1245/s10434-024-16244-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>For premalignant main duct intraductal papillary mucinous neoplasms (MD-IPMN), laparoscopic duodenum and spleen-preserving subtotal or total pancreatectomy (LDSP-STP/TP) seems to be a viable option for parenchyma-sparing pancreatectomy.</p><p><strong>Patients and methods: </strong>On the basis of the imaging features, family history, genomic alterations, intraoperative ultrasound examination, and frozen section evaluation, we have proposed patient selection strategies for the LDSP-STP/TP technique for the first time. Additionally, a comprehensive step-by-step overview of this technique has been provided. To date, we have performed five LDSP-STP procedures and one LDSP-TP procedure.</p><p><strong>Results: </strong>We successfully performed selective resection of the affected pancreatic parenchyma while preserving the duodenum, common bile duct (CBD), spleen, and splenic artery and vein. The operation time ranged from 295 to 495 min, with blood loss ranging from 100 to 300 mL. Postoperative pathological results revealed low-grade dysplasia in the resected pancreatic samples and margins. The patients resumed eating within 3-5 days after surgery, and all postoperative complications were classified as grade I according to the Clavien-Dindo classification. At the 3-month follow-up, there were no cases of CBD ischemic stenosis, splenic ischemia, or pseudocyst formation observed. For patients who received LDSP-STP, the longitudinal diameter of the remaining pancreatic tail ranged from 2.2 to 4.6 cm, and they demonstrated satisfactory long-term blood glycemic control.</p><p><strong>Conclusions: </strong>LDSP-STP/TP demonstrates technical feasibility and safety. It allows for the selective resection of the affected pancreatic parenchyma, thereby minimizing the impact of pancreatic functional impairment. However, it is crucial to validate this technique through long-term prospective observations.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549168/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Surgical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1245/s10434-024-16244-2","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/23 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: For premalignant main duct intraductal papillary mucinous neoplasms (MD-IPMN), laparoscopic duodenum and spleen-preserving subtotal or total pancreatectomy (LDSP-STP/TP) seems to be a viable option for parenchyma-sparing pancreatectomy.

Patients and methods: On the basis of the imaging features, family history, genomic alterations, intraoperative ultrasound examination, and frozen section evaluation, we have proposed patient selection strategies for the LDSP-STP/TP technique for the first time. Additionally, a comprehensive step-by-step overview of this technique has been provided. To date, we have performed five LDSP-STP procedures and one LDSP-TP procedure.

Results: We successfully performed selective resection of the affected pancreatic parenchyma while preserving the duodenum, common bile duct (CBD), spleen, and splenic artery and vein. The operation time ranged from 295 to 495 min, with blood loss ranging from 100 to 300 mL. Postoperative pathological results revealed low-grade dysplasia in the resected pancreatic samples and margins. The patients resumed eating within 3-5 days after surgery, and all postoperative complications were classified as grade I according to the Clavien-Dindo classification. At the 3-month follow-up, there were no cases of CBD ischemic stenosis, splenic ischemia, or pseudocyst formation observed. For patients who received LDSP-STP, the longitudinal diameter of the remaining pancreatic tail ranged from 2.2 to 4.6 cm, and they demonstrated satisfactory long-term blood glycemic control.

Conclusions: LDSP-STP/TP demonstrates technical feasibility and safety. It allows for the selective resection of the affected pancreatic parenchyma, thereby minimizing the impact of pancreatic functional impairment. However, it is crucial to validate this technique through long-term prospective observations.

腹腔镜十二指肠和脾脏保留次全或全胰切除术:主导管内乳头状黏液性肿瘤的实质保留策略(附视频)。
背景:对于前恶性主导管内乳头状黏液瘤(MD-IPMN),腹腔镜十二指肠和脾脏保留次全或全胰腺切除术(LDSP-STP/TP)似乎是保留胰腺实质切除术的可行选择:根据影像学特征、家族史、基因组改变、术中超声检查和冰冻切片评估,我们首次提出了 LDSP-STP/TP 技术的患者选择策略。此外,我们还提供了该技术的全面步骤概述。迄今为止,我们已经实施了五例 LDSP-STP 手术和一例 LDSP-TP 手术:结果:我们成功地对受影响的胰腺实质进行了选择性切除,同时保留了十二指肠、胆总管(CBD)、脾脏、脾动静脉。手术时间为 295 至 495 分钟,失血量为 100 至 300 毫升。术后病理结果显示,切除的胰腺样本和边缘存在低度发育不良。患者在术后 3-5 天内恢复进食,根据 Clavien-Dindo 分级法,所有术后并发症均为 I 级。在 3 个月的随访中,没有发现 CBD 缺血性狭窄、脾脏缺血或假性囊肿形成的病例。接受LDSP-STP治疗的患者,剩余胰尾的纵向直径在2.2厘米至4.6厘米之间,长期血糖控制令人满意:结论:LDSP-STP/TP具有技术可行性和安全性。结论:LDSP-STP/TP 证明了技术的可行性和安全性,它可以选择性切除受影响的胰腺实质,从而将胰腺功能障碍的影响降至最低。然而,通过长期前瞻性观察来验证这项技术至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
5.90
自引率
10.80%
发文量
1698
审稿时长
2.8 months
期刊介绍: The Annals of Surgical Oncology is the official journal of The Society of Surgical Oncology and is published for the Society by Springer. The Annals publishes original and educational manuscripts about oncology for surgeons from all specialities in academic and community settings.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信