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Erschienen in: Journal of Hepato-Biliary-Pancreatic Sciences 6/2010

01.11.2010 | Topics

Parenchyma-sparing resections for pancreatic neoplasms

verfasst von: Stefano Crippa, Letizia Boninsegna, Stefano Partelli, Massimo Falconi

Erschienen in: Journal of Hepato-Biliary-Pancreatic Sciences | Ausgabe 6/2010

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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.
Literatur
1.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Kahl S, Malfertheiner P. Exocrine and endocrine pancreatic insufficiency after pancreatic surgery. Best Pract Res Clin Gastroenterol. 2004;18:947–55.PubMed Kahl S, Malfertheiner P. Exocrine and endocrine pancreatic insufficiency after pancreatic surgery. Best Pract Res Clin Gastroenterol. 2004;18:947–55.PubMed
8.
Zurück zum Zitat Slezak LA, Andersen DK. Pancreatic resection: effects on glucose metabolism. World J Surg. 2001;25:452–60.CrossRefPubMed Slezak LA, Andersen DK. Pancreatic resection: effects on glucose metabolism. World J Surg. 2001;25:452–60.CrossRefPubMed
9.
Zurück zum Zitat Aranha GV, Shoup M. Nonstandard pancreatic resections for unusual lesions. Am J Surg. 2005;189:223–8.CrossRefPubMed Aranha GV, Shoup M. Nonstandard pancreatic resections for unusual lesions. Am J Surg. 2005;189:223–8.CrossRefPubMed
10.
Zurück zum Zitat Crippa S, Bassi C, Salvia R, Falconi M, Butturini G, Pederzoli P. Enucleation of pancreatic neoplasms. Br J Surg. 2007;94:1254–9.CrossRefPubMed 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Yeo CJ, Wang BH, Anthone GJ, Cameron JL. Surgical experience with pancreatic islet-cell tumors. Arch Surg. 1993;128:1143–8.PubMed Yeo CJ, Wang BH, Anthone GJ, Cameron JL. Surgical experience with pancreatic islet-cell tumors. Arch Surg. 1993;128:1143–8.PubMed
13.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Kiely JM, Nakeeb A, Komorowski RA, Wilson SD, Pitt HA. Cystic pancreatic neoplasms: enucleate or resect? J Gastrointest Surg. 2003;7:890–7.CrossRefPubMed 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Fernàndez-Cruz L, Cesar-Borges G. Laparoscopic strategies for resection of insulinomas. J Gastrointest Surg. 2006;10:752–60.CrossRefPubMed Fernàndez-Cruz L, Cesar-Borges G. Laparoscopic strategies for resection of insulinomas. J Gastrointest Surg. 2006;10:752–60.CrossRefPubMed
22.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Guillemin P, Bessot M. Pancreatite chronique calcifiante chez un tuberculeux renal: pancreatojejunostomie sion une technique originale. Mem Acad Chir. 1957;83:869–71.PubMed 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.
Zurück zum Zitat Dagradi A, Serio G. Pancreatectomia intermedia. In: Enciclopedia Medica Italiana. Pancreas, vol 11. Florence: Scientifiche; 1984. p. 850–1. Dagradi A, Serio G. Pancreatectomia intermedia. In: Enciclopedia Medica Italiana. Pancreas, vol 11. Florence: Scientifiche; 1984. p. 850–1.
27.
Zurück zum Zitat Roggin KK, Rudloff U, Blumgart LH, Brennan MF. Central pancreatectomy revisited. J Gastrointest Surg. 2006;10:804–12.CrossRefPubMed Roggin KK, Rudloff U, Blumgart LH, Brennan MF. Central pancreatectomy revisited. J Gastrointest Surg. 2006;10:804–12.CrossRefPubMed
28.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Fagniez PL, Kracht M, Rotman N. Limited conservative pancreatectomy for benign tumors: a new technical approach. Br J Surg. 1988;75:719.CrossRefPubMed Fagniez PL, Kracht M, Rotman N. Limited conservative pancreatectomy for benign tumors: a new technical approach. Br J Surg. 1988;75:719.CrossRefPubMed
33.
Zurück zum Zitat Rotman N, Satre B, Fagniez Pl. Medial pancreatectomy for tumors of the neck of the pancreas. Surgery. 1993;113:532–5.PubMed Rotman N, Satre B, Fagniez Pl. Medial pancreatectomy for tumors of the neck of the pancreas. Surgery. 1993;113:532–5.PubMed
34.
Zurück zum Zitat Iacono C, Bortolasi L, Serio G. Is there a place for central pancreatectomy in pancreatic surgery? J Gastrointest Surg. 1998;2:509–17.CrossRefPubMed 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.
Zurück zum Zitat Christein JD, Smoot RL, Farnell MB. Central pancreatectomy: a technique for the resection of pancreatic neck lesions. Arch Surg. 2006;141:293–9.CrossRefPubMed 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Efron DT, Lillemoe KD, Cameron JL, Yeo CJ. Central pancreatectomy with pancreaticogastrostomy for benign pancreatic pathology. J Gastrointest Surg. 2004;8:532–8.CrossRefPubMed 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Orsenigo E, Baccari P, Bussolotti G, Staudacher C. Laparoscopic central pancreatectomy. Am J Surg. 2006;191:549–52.CrossRefPubMed Orsenigo E, Baccari P, Bussolotti G, Staudacher C. Laparoscopic central pancreatectomy. Am J Surg. 2006;191:549–52.CrossRefPubMed
41.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Reber HA. Middle pancreatectomy: why I rarely do it. J Gastrointest Surg. 2007;11:726–9.CrossRef Reber HA. Middle pancreatectomy: why I rarely do it. J Gastrointest Surg. 2007;11:726–9.CrossRef
44.
Zurück zum Zitat Norton JA. Surgery for primary pancreatic neuroendocrine tumors. J Gastrointest Surg. 2006;10:327–31.CrossRefPubMed Norton JA. Surgery for primary pancreatic neuroendocrine tumors. J Gastrointest Surg. 2006;10:327–31.CrossRefPubMed
45.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Howard JM, Hess W. History of the pancreas: mystery of a hidden organ. New York: Kluwer Academic/Plenum Publisher; 2002. Howard JM, Hess W. History of the pancreas: mystery of a hidden organ. New York: Kluwer Academic/Plenum Publisher; 2002.
48.
Zurück zum Zitat 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 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.
Zurück zum Zitat Hiramoto JS, Feldstein VA, Laberge JM, Norton JA. Intraoperative ultrasound and preoperative localization detects all occult insulinomas. Arch Surg. 2001;136:1020–5.CrossRefPubMed 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.
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Crippa S, Fernandez-del Castillo C. Management of intraductal papillary mucinous neoplasms. Curr Gastroenterol Rep. 2008;10:136–43.CrossRefPubMed Crippa S, Fernandez-del Castillo C. Management of intraductal papillary mucinous neoplasms. Curr Gastroenterol Rep. 2008;10:136–43.CrossRefPubMed
Metadaten
Titel
Parenchyma-sparing resections for pancreatic neoplasms
verfasst von
Stefano Crippa
Letizia Boninsegna
Stefano Partelli
Massimo Falconi
Publikationsdatum
01.11.2010
Verlag
Springer Japan
Erschienen in
Journal of Hepato-Biliary-Pancreatic Sciences / Ausgabe 6/2010
Print ISSN: 1868-6974
Elektronische ISSN: 1868-6982
DOI
https://doi.org/10.1007/s00534-009-0224-1

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