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Erschienen in: Surgical Endoscopy 9/2019

12.11.2018

Robotic enucleations of pancreatic benign or low-grade malignant tumors: preliminary results and comparison with robotic demolitive resections

verfasst von: Ilenia Bartolini, Lapo Bencini, Marco Bernini, Marco Farsi, Massimo Calistri, Mario Annecchiarico, Luca Moraldi, Andrea Coratti

Erschienen in: Surgical Endoscopy | Ausgabe 9/2019

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Abstract

Background

The incidental detection of benign to low-grade malignant small pancreatic neoplasms increased in the last decades. The surgical management of these patients is still under debate. The aim of this paper is to evaluate the safety and feasibility of robotic enucleations and to compare the outcomes with non-parenchymal sparing robotic resections.

Methods

The study included a total of 25 patients. Nine of them underwent a robotic enucleation (EN Group) and 16 patients received a robotic demolitive resection (DR Group). Perioperative and medium-term outcomes were compared between the two groups.

Results

Patients’ baseline characteristics were similar in the two groups except for presence of symptoms and tumor size, due to the inclusion criteria. Operative time was significantly shorter and postoperative results were better for EN group, including a significant shorter hospitalization (5 vs. 8 days, p = 0.027), reduced pancreatic leaks (22% vs. 50%, p = 0.287) and a better preservation of glandular function (100% vs. 62.5%, p = 0.066). Mortality rate was zero in both groups, with all patients free from disease at a median follow-up of 18 months.

Conclusions

The risks of under/overtreatment remain still unavoidable for benign to low-grade malignant small pancreatic neoplasms. Simple enucleation should be performed whenever oncological appropriate, to achieve the best postoperative outcomes. The adoption of robotic technique might widen the indications for parenchymal sparing, minimally invasive surgery.
Literatur
1.
Zurück zum Zitat Lawrence B, Gustafsson BI, Chan A, Svejda B, Kidd M, Modlin IM (2011) The epidemiology of gastroenteropancreatic neuroendocrine tumors. Endocrinol Metab Clin North Am 40(1):1–18, viiCrossRef Lawrence B, Gustafsson BI, Chan A, Svejda B, Kidd M, Modlin IM (2011) The epidemiology of gastroenteropancreatic neuroendocrine tumors. Endocrinol Metab Clin North Am 40(1):1–18, viiCrossRef
2.
Zurück zum Zitat Sadot E, Reidy-Lagunes DL, Tang LH, Do RK, Gonen M, D’Angelica MI, DeMatteo RP, Kingham TP, Groot Koerkamp B, Untch BR, Brennan MF, Jarnagin WR, Allen PJ (2016) Observation versus Resection for small asymptomatic pancreatic neuroendocrine tumors: a matched case-control study. Ann Surg Oncol 23(4):1361–1370CrossRefPubMed Sadot E, Reidy-Lagunes DL, Tang LH, Do RK, Gonen M, D’Angelica MI, DeMatteo RP, Kingham TP, Groot Koerkamp B, Untch BR, Brennan MF, Jarnagin WR, Allen PJ (2016) Observation versus Resection for small asymptomatic pancreatic neuroendocrine tumors: a matched case-control study. Ann Surg Oncol 23(4):1361–1370CrossRefPubMed
3.
Zurück zum Zitat Sandvik OM, Søreide K, Gudlaugsson E, Kvaløy JT, Søreide JA (2016) Epidemiology and classification of gastroenteropancreatic neuroendocrine neoplasms using current coding criteria. Br J Surg 103(3):226–232CrossRef Sandvik OM, Søreide K, Gudlaugsson E, Kvaløy JT, Søreide JA (2016) Epidemiology and classification of gastroenteropancreatic neuroendocrine neoplasms using current coding criteria. Br J Surg 103(3):226–232CrossRef
4.
Zurück zum Zitat de Wilde RF, Edil BH, Hruban RH, Anirban M (2012) Well- differentiated pancreatic neuroendocrine tumors: from genetics to therapy. Nat Rev Gastroenterol Hepatol 9:199–208CrossRefPubMedPubMedCentral de Wilde RF, Edil BH, Hruban RH, Anirban M (2012) Well- differentiated pancreatic neuroendocrine tumors: from genetics to therapy. Nat Rev Gastroenterol Hepatol 9:199–208CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Liu JB, Baker MS (2016) Surgical Management of pancreatic neuroendocrine tumors. Surg Clin North Am 96(6):1447–1468CrossRefPubMed Liu JB, Baker MS (2016) Surgical Management of pancreatic neuroendocrine tumors. Surg Clin North Am 96(6):1447–1468CrossRefPubMed
6.
7.
Zurück zum Zitat Chabot J (2016) Pancreatic neuroendocrine tumors: Primum non nocere. Surgery 159(1):348–349CrossRefPubMed Chabot J (2016) Pancreatic neuroendocrine tumors: Primum non nocere. Surgery 159(1):348–349CrossRefPubMed
8.
Zurück zum Zitat Sharpe SM, In H, Winchester DJ, Talamonti MS, Baker MS (2015) Surgical resection provides an overall survival benefit for patients with small pancreatic neuroendocrine tumors. J Gastrointest Surg 19(1):117–123; discussion 123CrossRef Sharpe SM, In H, Winchester DJ, Talamonti MS, Baker MS (2015) Surgical resection provides an overall survival benefit for patients with small pancreatic neuroendocrine tumors. J Gastrointest Surg 19(1):117–123; discussion 123CrossRef
9.
Zurück zum Zitat Zhang IY, Zhao J, Fernandez-Del Castillo C, Braun Y, Razmdjou S, Warshaw AL, Lillemoe KD, Ferrone CR (2016) Operative versus nonoperative management of nonfunctioning pancreatic neuroendocrine tumors. J Gastrointest Surg 20(2):277–283CrossRefPubMed Zhang IY, Zhao J, Fernandez-Del Castillo C, Braun Y, Razmdjou S, Warshaw AL, Lillemoe KD, Ferrone CR (2016) Operative versus nonoperative management of nonfunctioning pancreatic neuroendocrine tumors. J Gastrointest Surg 20(2):277–283CrossRefPubMed
10.
Zurück zum Zitat Falconi M, Zerbi A, Crippa S, Balzano G, Boninsegna L, Capitanio V, Bassi C, Di Carlo V, Pederzoli P (2010) Parenchyma-preserving resections for small nonfunctioning pancreatic endocrine tumors. Ann Surg Oncol 17:1621–1627CrossRefPubMed Falconi M, Zerbi A, Crippa S, Balzano G, Boninsegna L, Capitanio V, Bassi C, Di Carlo V, Pederzoli P (2010) Parenchyma-preserving resections for small nonfunctioning pancreatic endocrine tumors. Ann Surg Oncol 17:1621–1627CrossRefPubMed
11.
Zurück zum Zitat Sakorafas GH, Smyrniotis V, Reid-Lombardo KM, Sarr MG (2011) Primary pancreatic cystic neoplasms revisited. Part I: serous cystic neoplasms. Surg Oncol 20:e84–e92CrossRefPubMed Sakorafas GH, Smyrniotis V, Reid-Lombardo KM, Sarr MG (2011) Primary pancreatic cystic neoplasms revisited. Part I: serous cystic neoplasms. Surg Oncol 20:e84–e92CrossRefPubMed
12.
Zurück zum Zitat Pitt SC, Pitt HA, Baker MS, Christians K, Touzios JG, Kiely JM, Weber SM, Wilson SD, Howard TJ, Talamonti MS, Rikkers LF (2009) Small pancreatic and periampullary neuroendocrine tumors: resect or enucleate? J Gastrointest Surg 13:1692–1698CrossRefPubMedPubMedCentral Pitt SC, Pitt HA, Baker MS, Christians K, Touzios JG, Kiely JM, Weber SM, Wilson SD, Howard TJ, Talamonti MS, Rikkers LF (2009) Small pancreatic and periampullary neuroendocrine tumors: resect or enucleate? J Gastrointest Surg 13:1692–1698CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Hüttner FJ, Koessler-Ebs J, Hackert T, Ulrich A, Büchler MW, Diener MK (2015) Meta-analysis of surgical outcome after enucleation versus standard resection for pancreatic neoplasms. Br J Surg 102(9):1026–1036CrossRefPubMed Hüttner FJ, Koessler-Ebs J, Hackert T, Ulrich A, Büchler MW, Diener MK (2015) Meta-analysis of surgical outcome after enucleation versus standard resection for pancreatic neoplasms. Br J Surg 102(9):1026–1036CrossRefPubMed
15.
Zurück zum Zitat Gooiker GA, Lemmens VE, Besselink MG, Busch OR, Bonsing BA, Molenaar IQ, Tollenaar RA, de Hingh IH, Wouters MW (2014) Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br J Surg 101(8):1000–1005CrossRefPubMed Gooiker GA, Lemmens VE, Besselink MG, Busch OR, Bonsing BA, Molenaar IQ, Tollenaar RA, de Hingh IH, Wouters MW (2014) Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br J Surg 101(8):1000–1005CrossRefPubMed
16.
Zurück zum Zitat Zureikat AH, Moser AJ, Boone BA, Bartlett DL, Zenati M, Zeh HJ 3rd (2013) 250 robotic pancreatic resections: safety and feasibility. Ann Surg 258(4):554–559; discussion 559 – 62CrossRefPubMedPubMedCentral Zureikat AH, Moser AJ, Boone BA, Bartlett DL, Zenati M, Zeh HJ 3rd (2013) 250 robotic pancreatic resections: safety and feasibility. Ann Surg 258(4):554–559; discussion 559 – 62CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Milone L, Daskalaki D, Wang X, Giulianotti PC (2013) State of the art of robotic pancreatic surgery. World J Surg 37(12):2761–2770CrossRefPubMed Milone L, Daskalaki D, Wang X, Giulianotti PC (2013) State of the art of robotic pancreatic surgery. World J Surg 37(12):2761–2770CrossRefPubMed
18.
Zurück zum Zitat Boggi U, Napoli N, Costa F, Kauffmann EF, Menonna F, Iacopi S, Vistoli F, Amorese G (2016) Robotic-assisted pancreatic resections. World J Surg 40(10):2497–2506CrossRefPubMed Boggi U, Napoli N, Costa F, Kauffmann EF, Menonna F, Iacopi S, Vistoli F, Amorese G (2016) Robotic-assisted pancreatic resections. World J Surg 40(10):2497–2506CrossRefPubMed
19.
Zurück zum Zitat Tanaka M, Fernández-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, Kimura W, Levy P, Pitman MB, Schmidt CM, Shimizu M, Wolfgang CL, Yamaguchi K, Yamao K (2012) International association of pancreatology. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12:183–197CrossRefPubMed Tanaka M, Fernández-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, Kimura W, Levy P, Pitman MB, Schmidt CM, Shimizu M, Wolfgang CL, Yamaguchi K, Yamao K (2012) International association of pancreatology. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12:183–197CrossRefPubMed
20.
Zurück zum Zitat Coratti A, Di Marino M, Coratti F, Baldoni G, Guerra F, Amore Bonapasta S, Bencini L, Farsi M, Annecchiarico M (2016) Initial experience with robotic pancreatic surgery: technical feasibility and oncological implications. Surg Laparosc Endosc Percutan Tech 26(1):31–37CrossRefPubMed Coratti A, Di Marino M, Coratti F, Baldoni G, Guerra F, Amore Bonapasta S, Bencini L, Farsi M, Annecchiarico M (2016) Initial experience with robotic pancreatic surgery: technical feasibility and oncological implications. Surg Laparosc Endosc Percutan Tech 26(1):31–37CrossRefPubMed
21.
Zurück zum Zitat Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) International study group on pancreatic fistula definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13CrossRef Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) International study group on pancreatic fistula definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13CrossRef
22.
Zurück zum Zitat Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefPubMed Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefPubMed
23.
Zurück zum Zitat Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS) (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperativepancreatic fistula: 11 years after. Surgery 161(3):584–591CrossRef Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS) (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperativepancreatic fistula: 11 years after. Surgery 161(3):584–591CrossRef
24.
Zurück zum Zitat Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, Kos-Kudla B, Kwekkeboom D, Rindi G, Klöppel G, Reed N, Kianmanesh R, Jensen RT, Vienna Consensus Conference participants (2016) ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology 103(2):153–171CrossRef Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, Kos-Kudla B, Kwekkeboom D, Rindi G, Klöppel G, Reed N, Kianmanesh R, Jensen RT, Vienna Consensus Conference participants (2016) ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology 103(2):153–171CrossRef
25.
Zurück zum Zitat Singh S, Dey C, Kennecke H, Kocha W, Maroun J, Metrakos P, Mukhtar T, Pasieka J, Rayson D, Rowsell C, Sideris L, Wong R, Law C (2015) Consensus recommendations for the diagnosis and management of pancreatic neuroendocrinetumors: guidelines from a canadian national expert group. Ann Surg Oncol 22(8):2685–2699CrossRefPubMed Singh S, Dey C, Kennecke H, Kocha W, Maroun J, Metrakos P, Mukhtar T, Pasieka J, Rayson D, Rowsell C, Sideris L, Wong R, Law C (2015) Consensus recommendations for the diagnosis and management of pancreatic neuroendocrinetumors: guidelines from a canadian national expert group. Ann Surg Oncol 22(8):2685–2699CrossRefPubMed
26.
Zurück zum Zitat Rosenberg AM, Friedmann P, Del Rivero J, Libutti SK, Laird AM (2016) Resection versus expectant management of small incidentally discovered nonfunctional pancreatic neuroendocrine tumors. Surgery 159(1):302–309CrossRefPubMed Rosenberg AM, Friedmann P, Del Rivero J, Libutti SK, Laird AM (2016) Resection versus expectant management of small incidentally discovered nonfunctional pancreatic neuroendocrine tumors. Surgery 159(1):302–309CrossRefPubMed
27.
Zurück zum Zitat Regenet N, Carrere N, Boulanger G, de Calan L, Humeau M, Arnault V, Kraimps JL, Mathonnet M (2016) Is the 2-cm size cutoff relevant for small nonfunctioning pancreatic neuroendocrine tumors: A French multicenter study. Surgery 159(3):901–907CrossRefPubMed Regenet N, Carrere N, Boulanger G, de Calan L, Humeau M, Arnault V, Kraimps JL, Mathonnet M (2016) Is the 2-cm size cutoff relevant for small nonfunctioning pancreatic neuroendocrine tumors: A French multicenter study. Surgery 159(3):901–907CrossRefPubMed
28.
Zurück zum Zitat Gratian L, Pura J, Dinan M, Roman S, Reed S, Sosa JA (2014) Impact of extent of surgery on survival in patients with small nonfunctional pancreatic neuroendocrine tumors in the United States. Ann Surg Oncol 21(11):3515–3521CrossRefPubMedPubMedCentral Gratian L, Pura J, Dinan M, Roman S, Reed S, Sosa JA (2014) Impact of extent of surgery on survival in patients with small nonfunctional pancreatic neuroendocrine tumors in the United States. Ann Surg Oncol 21(11):3515–3521CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Kuo EJ, Salem RR (2013) Population-level analysis of pancreatic neuroendocrine tumors 2 cm or less in size. Ann Surg Oncol 20(9):2815–2821CrossRef Kuo EJ, Salem RR (2013) Population-level analysis of pancreatic neuroendocrine tumors 2 cm or less in size. Ann Surg Oncol 20(9):2815–2821CrossRef
30.
Zurück zum Zitat Lombardi M, De Lio N, Funel N, Sardella C, Russo D, Urbani C, Rossi G, Campani D, Martino E, Marcocci C, Boggi U, Bogazzi F (2015) Prognostic factors for pancreatic neuroendocrine neoplasms (pNET) and the risk of small non-functioning pNET. J Endocrinol Invest 38(6):605–613CrossRefPubMed Lombardi M, De Lio N, Funel N, Sardella C, Russo D, Urbani C, Rossi G, Campani D, Martino E, Marcocci C, Boggi U, Bogazzi F (2015) Prognostic factors for pancreatic neuroendocrine neoplasms (pNET) and the risk of small non-functioning pNET. J Endocrinol Invest 38(6):605–613CrossRefPubMed
31.
Zurück zum Zitat Lee SE, Jang JY, Hwang DW, Park KW, Kim SW (2008) Clinical features and outcome of solid pseudopapillary neoplasm: differences between adults and children. Arch Surg 143:1218–1221CrossRefPubMed Lee SE, Jang JY, Hwang DW, Park KW, Kim SW (2008) Clinical features and outcome of solid pseudopapillary neoplasm: differences between adults and children. Arch Surg 143:1218–1221CrossRefPubMed
32.
Zurück zum Zitat Shi Y, Peng C, Shen B, Deng X, Jin J, Wu Z, Zhan Q, Li H (2016) Pancreatic enucleation using the da Vinci robotic surgical system: a report of 26 cases. Int J Med Robot 12(4):751–757CrossRefPubMed Shi Y, Peng C, Shen B, Deng X, Jin J, Wu Z, Zhan Q, Li H (2016) Pancreatic enucleation using the da Vinci robotic surgical system: a report of 26 cases. Int J Med Robot 12(4):751–757CrossRefPubMed
33.
Zurück zum Zitat Beger HG, Siech M, Poch B, Mayer B, Schoenberg MH (2015) Limited surgery for benign tumours of the pancreas: a systematic review. World J Surg 39(6):1557–1566CrossRef Beger HG, Siech M, Poch B, Mayer B, Schoenberg MH (2015) Limited surgery for benign tumours of the pancreas: a systematic review. World J Surg 39(6):1557–1566CrossRef
34.
Zurück zum Zitat Cauley CE, Pitt HA, Ziegler KM, Nakeeb A, Schmidt CM, Zyromski NJ, House MG, Lillemoe KD (2012) Pancreatic enucleation: improved outcomes compared to resection. J Gastrointest Surg 16:1347–1353CrossRefPubMed Cauley CE, Pitt HA, Ziegler KM, Nakeeb A, Schmidt CM, Zyromski NJ, House MG, Lillemoe KD (2012) Pancreatic enucleation: improved outcomes compared to resection. J Gastrointest Surg 16:1347–1353CrossRefPubMed
35.
Zurück zum Zitat Choi KS, Chung JC, Kim HY (2014) Feasibility and outcomes of laparoscopic enucleation for pancreatic neoplasms. Ann Surg Treat Res 87(6):285–289CrossRefPubMedPubMedCentral Choi KS, Chung JC, Kim HY (2014) Feasibility and outcomes of laparoscopic enucleation for pancreatic neoplasms. Ann Surg Treat Res 87(6):285–289CrossRefPubMedPubMedCentral
36.
Zurück zum Zitat Zhou Y, Zhao M, Wu L, Ye F, Si X (2016) Short- and long-term outcomes after enucleation of pancreatic tumors: An evidence-based assessment. Pancreatology 16(6):1092–1098CrossRefPubMed Zhou Y, Zhao M, Wu L, Ye F, Si X (2016) Short- and long-term outcomes after enucleation of pancreatic tumors: An evidence-based assessment. Pancreatology 16(6):1092–1098CrossRefPubMed
37.
Zurück zum Zitat Jin JB, Qin K, Li H, Wu ZC, Zhan Q, Deng XX, Chen H, Shen BY, Peng CH, Li HW (2016) Robotic enucleation for benign or borderline tumours of the pancreas: a retrospective analysis and comparison from a high-volume centre in Asia. World J Surg 40(12):3009–3020CrossRefPubMed Jin JB, Qin K, Li H, Wu ZC, Zhan Q, Deng XX, Chen H, Shen BY, Peng CH, Li HW (2016) Robotic enucleation for benign or borderline tumours of the pancreas: a retrospective analysis and comparison from a high-volume centre in Asia. World J Surg 40(12):3009–3020CrossRefPubMed
38.
Zurück zum Zitat Hackert T, Hinz U, Fritz S, Strobel O, Schneider L, Hartwig W, Büchler MW, Werner J (2011) Enucleation in pancreatic surgery: indications, technique, and outcome. Langenbecks Arch Surg 396(8):1197–1203CrossRefPubMed Hackert T, Hinz U, Fritz S, Strobel O, Schneider L, Hartwig W, Büchler MW, Werner J (2011) Enucleation in pancreatic surgery: indications, technique, and outcome. Langenbecks Arch Surg 396(8):1197–1203CrossRefPubMed
39.
Zurück zum Zitat Jilesen AP, van Eijck CH, Busch OR, van Gulik TM, Gouma DJ, Nieveen van Dijkum EJ (2016) Postoperative outcomes of enucleation and standard resections in patients with a pancreatic neuroendocrine tumor. World J Surg 40:715e28 Jilesen AP, van Eijck CH, Busch OR, van Gulik TM, Gouma DJ, Nieveen van Dijkum EJ (2016) Postoperative outcomes of enucleation and standard resections in patients with a pancreatic neuroendocrine tumor. World J Surg 40:715e28
40.
Zurück zum Zitat Sperti C, Beltrame V, Milanetto AC, Moro M, Pedrazzoli S (2010) Parenchyma-sparing pancreatectomies for benign or border-line tumors of the pancreas. World J Gastrointest Oncol 2:272–281CrossRefPubMedPubMedCentral Sperti C, Beltrame V, Milanetto AC, Moro M, Pedrazzoli S (2010) Parenchyma-sparing pancreatectomies for benign or border-line tumors of the pancreas. World J Gastrointest Oncol 2:272–281CrossRefPubMedPubMedCentral
41.
Zurück zum Zitat Tian F, Hong XF, Wu WM, Han XL, Wang MY, Cong L, Dai MH, Liao Q, Zhang TP, Zhao YP (2016) Propensity score-matched analysis of robotic versus open surgical enucleation for small pancreatic neuroendocrine tumours. Br J Surg 103(10):1358–1364CrossRefPubMed Tian F, Hong XF, Wu WM, Han XL, Wang MY, Cong L, Dai MH, Liao Q, Zhang TP, Zhao YP (2016) Propensity score-matched analysis of robotic versus open surgical enucleation for small pancreatic neuroendocrine tumours. Br J Surg 103(10):1358–1364CrossRefPubMed
42.
Zurück zum Zitat Crippa S, Pergolini I, Rubini C, Castelli P, Partelli S, Zardini C, Marchesini G, Zamboni G, Falconi M (2016) Risk of misdiagnosis and overtreatment in patients with main pancreatic duct dilatation and suspected combined/main-duct intraductal papillary mucinous neoplasms. Surgery 159(4):1041–1049CrossRefPubMed Crippa S, Pergolini I, Rubini C, Castelli P, Partelli S, Zardini C, Marchesini G, Zamboni G, Falconi M (2016) Risk of misdiagnosis and overtreatment in patients with main pancreatic duct dilatation and suspected combined/main-duct intraductal papillary mucinous neoplasms. Surgery 159(4):1041–1049CrossRefPubMed
Metadaten
Titel
Robotic enucleations of pancreatic benign or low-grade malignant tumors: preliminary results and comparison with robotic demolitive resections
verfasst von
Ilenia Bartolini
Lapo Bencini
Marco Bernini
Marco Farsi
Massimo Calistri
Mario Annecchiarico
Luca Moraldi
Andrea Coratti
Publikationsdatum
12.11.2018
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 9/2019
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6576-3

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Appendizitis BDC Leitlinien Webinare
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Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.