ReviewsNonstandard pancreatic resections for unusual lesions
Section snippets
Pancreatic enucleation
Benign or low-malignant potential tumors of the pancreas have traditionally been treated with standard resection. Such procedures, although oncologically sound, involve resection of a notable amount of normal parenchyma in patients with benign disease. Enucleation of these tumors has the advantage of preserving pancreatic parenchyma as well as the spleen, without the morbidity, mortality, or late sequelae of extensive resection [1], [2], [3], [4], [5], [6], [7], [8], [9], [10].
Lesions that may
Central pancreatectomy
Enucleation of benign or low-grade malignant tumor types is not always possible because of pancreatic duct involvement or because of a pancreatic neck or body location. These patients have traditionally been treated with a distal subtotal pancreatectomy or extended pancreaticoduodenectomy. Recently, central pancreatectomy has gained much attention [17], [18], [19], [20], [21], [22], [23], [24], [25]. Central or median pancreatectomy involves a limited resection of the midportion of the
Splenic-preserving distal pancreatectomy
Distal pancreatectomy for distal tumors has traditionally included splenectomy. Over the past decade, the addition of splenectomy to other major upper abdominal organ resection has been associated with increased postoperative morbidity, especially infectious complications, and therefore, when possible, splenic preservation is considered the standard of care in patients undergoing gastric or colon resection [27], [28], [29]. Splenectomy in conjunction with distal pancreatectomy is clearly
Duodenal-preserving resection of the head of the pancreas
Patients with chronic pancreatitis and severe pain pose a therapeutic challenge [39]. In up to one third of patients with chronic pancreatitis, an inflammatory mass develops in the head of the pancreas, often resulting in common bile duct and duodenal stenosis [40]. This group of patients usually has abdominal pain that is refractory to analgesic treatment, with local complications [41], [42]. For these patients, pancreatectomy or lateral pancreaticojejunostomy have been the standard procedures
Conclusion
Pancreaticoduodenectomy and distal pancreatectomy with splenectomy are the standard operations recommended for patients with pancreatic carcinoma. Nonstandard resections for unusual pancreatic tumors should be considered in select patients. The procedures described have thus far been found to be safe and effective, with appropriate preservation of endocrine and exocrine function.
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Cited by (60)
Pancreatic neuroendocrine tumors: Challenges in an underestimated disease
2016, Critical Reviews in Oncology/HematologyRoux-en-Y pancreaticojejunostomy reconstruction after deep enucleation of benign or borderline pancreatic lesions: a single-institution experience
2016, HPBCitation Excerpt :The widespread use of high-resolution imaging and periodic medical examinations has increased the diagnosis of benign or borderline pancreatic neoplasms. Standard pancreatectomy, including pancreaticoduodenectomy and distal pancreatectomy, is no longer advocated for benign or borderline neoplasms because of its high postoperative morbidity and long-term complications, such as endocrine and exocrine insufficiency or immune disorders.1–3 Alternative surgical procedures for parenchyma-sparing pancreatectomy such as enucleation, resection of the uncinate process, duodenal-preserving resection of the pancreatic head and central pancreatectomy, have been proposed in this setting.3–5
Conservative management and parenchyma-sparing resections of pancreatic neuroendocrine tumors: Literature review
2015, International Journal of SurgerySporadic nonfunctioning pancreatic neuroendocrine tumors: Prognostic significance of incidental diagnosis
2014, Surgery (United States)Citation Excerpt :Consequently, in our opinion standard pancreatic resections should be limited to large (>2 cm in diameter) and aggressive tumors requiring extensive lymphadenectomy. Conversely, parenchyma-sparing procedures could be offered to less aggressive PNET,4,47 this includes NF-PNET less than 2 cm, especially when incidentally-discovered.48 In our experience, about two-thirds of patients with incidentally diagnosed lesion underwent PSP, ie, every time than their anatomical location allowed it.
Patients get more long-term benefit from central pancreatectomy than distal resection: A meta-analysis
2013, European Journal of Surgical Oncology