Comparison of laparoscopic versus open distal pancreatectomy for benign, pre-malignant, and low grade malignant pancreatic tumors

Sang Hwa Song,Hee Joon Kim,Eun Kyu Park,Young Hoe Hur,Yang Seok Koh,Chol Kyoon Cho 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.1

Backgrounds/Aims: The purpose of this study is to demonstrate that laparoscopic distal pancreatectomy in benign disease is is safer and more favorable to patients than open distal pancreatectomy. Methods: We retrospectively reviewed data of 150 patients who underwent laparoscopic (n=69) or open (=81) distal pancreatectomy at a double institutes from 2008 to 2018. We reviewed each patient’s history for age, sex, pathologic diagnosis. Specific outcomes that were included hospital stay, operative time (in minutes), operative blood loss (in milliliters), 30-daymajormorbidity and mortality (Clavian-Dindo classification), pancreatic leak rate (grade of leak A, B, or C), pancreatic hemorrhage. Results: From 2008 to 2018, there were 150 patients underwent distal pancreatectomy with or without splenectomy for benign pancreatic disease. 81 patients underwent open and 69 patients underwent laparoscopic distal pancreatectomy (LDP) Intra-operative estimated blood loss was significantly lower in the LDP group than in the OPD group (200 vs. 400 ml p<0.01). There was no difference in blood transfusion between the two groups. There was a significant difference in the resection method between the two groups (p<0.01) and there was a significant difference in the use of mesh for prevention of postoperative pancreatic fistula (POPF) (53 vs. 34 p<0.01). There was no significant difference in incidence of POPF (15.9% in LDP vs 7.4% in ODP, p=0.235) between the two groups, morbidity rate between the two groups (18 vs. 30 p=0.152), post - pancreatectomy hemorrhage, wound infection, hospital stay and readmission. Conclusions: LDP showed there was no difference in the occurrence of POPF, complication and hospital stay. In contrast, intra-operative blood loss was significantly lower in the LDP group than in the ODP group, and LDP was also significantly better in the view point of the feeding advance. In other words, LDP is safer and more favorable to patients than ODP.

Does international study group on pancreatic fistula (ISGPF) classification need modification after distal pancreatectomy?

In Geol Ho,Jae Keun Kim,Ho Kyoung Hwang,Jae Young Kim,Joon Seong Park,Dong Sup Yoon 한국간담췌외과학회 2014 한국간담췌외과학회지 Vol.18 No.3

Backgrounds/Aims: Few reports have validated the clinical postoperative pancreatic fistula (PF) after distal pancreatectomy. The study intended to validate the predictability for clinical PF of drain amylase and lipase and to find out more appropriate postoperative day (POD) for diagnostic criterion of PF. Methods: A total of 154 patients underwent distal pancreatectomy. We used the clinical database registry system of the Gangnam Severance Hospital and Severance Hospital, Yonsei University Health System for these analyses. The receiver operating characteristic curve of the drain amylase or lipase concentration on each day was used to predict clinical PF (International Study Group on Pancreatic Fistula [ISGPF] grade B or C) and areas under the curves (AUC) were compared. Results: Amylase and lipase AUC values poorly predicted clinical PF before POD 3 and, gradually increased until POD 5 and became well correlated with clinical PF (ISGPF grade B or C). In contrast, the prediction of clinical PF using drain lipase did not differ from that using drain amylase. The drain amylase concentration on POD 6 was most precisely correlated with clinical PF. Conclusions: Clinical PF prediction was validated by using drain amylase and lipase concentrations, in which drain amylase assessment at POD 6 appeared to be an appropriate diagnostic criterion of PF after distal pancreatectomy. We suggest some modification of ISGPF definition, especially for distal pancreatectomy.

Pancreatic Diabetes after Distal Pancreatectomy

Ka-Jeong Kim,Chi-Young Jeong,Sang-Ho Jeong,Young-Tae Ju,Eun-Jung Jung,Young-Joon Lee,Sang-Kyung Choi,Woo-song Ha,Soon-Tae Park,Soon-Chan Hong 한국간담췌외과학회 2011 한국간담췌외과학회지 Vol.15 No.2

Purpose: Pancreatectomy can impair production of endocrine and exocrine hormones. In this study, we evaluated: 1) the incidence rate of diabetes in patients undergoing distal pancreatectomy; 2) the correlation between the occurrence of pancreatic diabetes and the extent of the resected pancreas; and 3) factors associated with the development of pancreatic diabetes. Methods: We retrospectively reviewed the cases of 26 patients who could be compared in abdominal computed tomography before and after distal pancreatectomy for benign or malignant lesions between January, 1999 to June, 2010. Results: The incidence of pancreatic diabetes was 19.2%. Obese patients (BMI>25.0 kg/m2) had a higher incidence (p=0.029) of pancreatic diabetes after distal pancreatectomy than non-obese patients. The diabetes group had larger volumes of resected pancreas, but the difference was not statistically significant (p=0.105). Conclusion: Several factors may be associated with the development of pancreatic diabetes after distal pancreatectomy. It is necessary to closely follow-up development of pancreatic diabetes regardless of the extent of resection

로봇 원위부 췌장 절제술의 초기 경험: 28례의 단일 기관 연구

이경록,백남현,정우현,김지훈,김욱환 대한내시경복강경외과학회 2016 Journal of Minimally Invasive Surgery Vol.19 No.4

Purpose: Surgical procedures using robot-assisted surgery, including pancreatic surgery, have recently become popular. This study aimed to report our initial experiences with distal pancreatectomy procedures using the robot-assisted surgery system.Methods: The clinical records of 28 patients who underwent robot-assisted distal pancreatectomy (RDP) between July 2012 and January 2016 were reviewed. Results: Of the 28 patients, 5 (17.9%) were male and 23 (82.1%) were female. Their ages ranged from 11 to 78 years, with a median age of 44.5 years. The mean diameter of the pancreatic tumors was 3.6 cm. The median operative time was 192.5 (range, 100~390) minutes, and the median blood loss was 200 (range, 50~1,900) ml. All of the 28 RDPs were successfully completed. Spleen preservation was achieved in 16 (57.1%) patients. Clinically significant postoperative pancreatic fistula was detected in 4 (14.3%) patients. Postoperative complications were evident in 5 (17.9%) of the 28 patients. Conclusion: Our experiences suggest that RDP is feasible for patients with benign or borderline tumors at the body or tail of the pancreas. It may be considered as an effective surgical procedure for benign or borderline tumors of the pancreas in the future; however, further studies to confirm this are warranted.

First Single-Port Laparoscopic Pancreatectomy in Regional Clinical Hospital Shymkent

( Nurgissa Shaldarbekov ),( Bekken Zhanaidar ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Pancreatic surgery is an extremely challenging field, and the management of pancreatic diseases continues to evolve. In the past decade, minimal access surgery is moving towards minimizing the surgical trauma by reducing numbers and size of the port. In the last few years, a novel technique with a single-incision laparoscopic approach has been described for several laparoscopic procedures. We present a single-port laparoscopic spleen-preserving distal pancreatectomy. To our knowledge, this is the first single-port pancreatic resection in Regional Clinical Hospital Shymkent. Methods: A 35-year-old woman with neuroendocrine tumor underwent spleen-preserving distal pancreatectomy via single- port approach. A single-incision advanced access platform with gelatin cap, self-retaining sleeve and wound protector was used. Results: Operative time was 182 minutes. Blood loss was minimal, and the patient did not receive a transfusion. The recovery was uneventful, and the patient was discharged on postoperative day 4. Conclusions: Single-port laparoscopic spleen-preserving distal pancreatectomy is feasible and can be safely performed in specialized centers by skilled laparoscopic surgeons.

Complication analysis of distal pancreatectomy based on early personal experience

Sung-Jin Park,Hyung-Il Seo,Soo-Hee Go,Sung-Pil Yun,Ji-Yeon Lee 한국간담췌외과학회 2011 한국간담췌외과학회지 Vol.15 No.4

Backgrounds/Aims: The objective of this study was to evaluate the relationship between initial personal experiences with distal pancreatectomy and perioperative risk factors, outcomes, and management of pancreatic fistulas. Methods: Between May, 2007 and May, 2010, a total of 28 patients who had undergone elective distal pancreatectomy were evaluated for this study. Perioperative factors and the occurrence of pancreatic fistula were analyzed on the basis of International Study Group of Pancreatic Fistula (ISGPF) criteria. Results: There were sixteen cases of benign neoplasms and twelve cases of malignant tumors. The remnant pancreas was manually sutured with ligation of the pancreatic duct (n=14), auto-suture stapling along with manual sutures (n=12), or stapling alone (n=2). According to the ISGPF classification, morbidity and mortality associated with pancreatic fistulas was 42.9% (n=12) and 0%, respectively. These pancreatic fistulae were classified as grade A in 8 cases (28.6%), grade B in 3 cases (10.7%), and grade C in one case (3.6%). All patients with pancreatic fistula were treated conservatively. Conclusions: Perioperative factors do not affect the risk of pancreatic fistula. Adequate drainage is the most effective method for management of a pancreatic fistula after distal pancreatectomy. (Korean J Hepatobiliary Pancreat Surg 2011;15:243-247)

원위부 췌장 절제에 있어서 복강경 수술과 개복 수술의 비교: 수술 후 췌장루 발생을 중심으로

박호종,나양원,남창우,방성조 대한내시경복강경외과학회 2011 Journal of Minimally Invasive Surgery Vol.14 No.2

Purpose: To assess the technical feasibility of laparoscopic distal pancreatectomy (LDP) focusing on the development of postoperative complications including pancreatic fistula (POPF). Methods: From March 2001 to April 2010, 57 patients underwent a distal pancreatectomy. The patients were divided into two groups, LDP group (L group, n=15) and open distal pancreatectomy group (O group, n=42). The clinicopathological characteristics, surgical variables and postoperative outcomes of these 2 groups were compared retrospectively. Results: Patients with a malignancy constituted 7% of the L group and 31% of the O group (p=0.084). The tumor size was significantly larger in the O group (2.6 vs. 5.3 cm). The body mass index (BMI) was significantly higher in the L group (24.9 vs. 22.9 kg/m2). One case of a pancreas pseudocyst in the L group was converted to open surgery due to intraoperative bleeding. The L group showed significantly less intraoperative bleeding, earlier start of solid meals and shorter hospital stay. There was no significant difference in the incidence of postoperative complications and POPF between the 2 groups. POPF of ISGPF grade B developed in 0 and 2 patients in the L group and O group, respectively. One intestinal obstruction and 1 fluid collection that required intervention was encountered in the O group. One patient with adenocarcinoma who underwent LDP was alive 25 months after surgery without recurrence. Conclusion: LDP provides the advantages of minimal access surgery with a comparable rate of POPF to ODP. LDP is considered suitable for benign and borderline-malignant pancreatic lesions.

영아에서 발생한 췌도모세포증의 외과적 치료 1예

허영수,채상철,나목찬,김미진,Huh, Young-Soo,Chai, Sang-Chul,Nah, Mok-Chan,Kim, Mi-Jin 대한소아외과학회 1995 소아외과 Vol.1 No.2

Nesidioblastosis in one of the causes of hyperinsulinemic hypoglysemia in infancy. The most important goal of treatment for persistent hypoglycemia is the prevention of permanent brain damage. The early surgical management is satisfactory to this goal in nesidioblastosis and maintains normal blood sugar level without administration of drugs or supplement of sugar postoperatively in many cases. We experienced a female infant of 3 months old who has suffered from persistent hypoglysemia due to hyperinsulinism and was suspected nesidioblastosis for its cause clinically. She underwent 95% distal pancreatectomy. The histologic findings of nesidioblastosis was confirmed postoperatively. No postoperative complication was occured and her blood sugar levels were maintained within normal range without medical treatment.

Distal pancreatectomy outcomes: Perspectives from a community-based teaching institution

Muhammad Umair Bashir,Apostolos Kandilis,Nancy M. Jackson,Janak A. Parikh,Michael J. Jacobs 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.2

Backgrounds/Aims: Distal pancreatic resections are intricate operations with potential for significant morbidity; there is controversy surrounding the appropriate setting regarding surgeon/hospital volume. We report our distal pancreatectomy experience from a community-based teaching hospital. Methods: This study includes all patients who underwent laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP) for benign and malignant lesions between June 2004 and October 2017. Both groups were compared for perioperative characteristics, parenchymal resection technique, and outcomes. Results: 138 patients underwent distal pancreatectomy during this time. The distribution of LDP and ODP was 68 and 70 respectively. Operative time (146 vs. 174 min), blood loss (139 vs. 395 ml) and mean length of stay (4.8 vs. 8.0 days) were significantly lower in the laparoscopic group. The 30-day Clavien Grade 2/3 morbidity rate was 13.7% (19/138) and the incidence of Grade B/C pancreatic fistula was 6.5% (9/138), with no difference between ODP and LDP. 30-day mortality was 0.7% (1/138). 61/138 resections had a malignancy on final pathology. ODP mean tumor diameter was greater (6.4 cm vs. 2.9 cm), but there was no significant difference in the mean number of harvested nodes (8.6 vs. 7.4). The cost of hospitalization, including readmissions and surgery was significantly lower for LDP ($7558 vs. $11610). Conclusions: This series of distal pancreatectomies indicates a shorter hospital stay, less operative blood loss and reduced cost in the LDP group, and comparable morbidity and oncologic outcomes between LDP and ODP. It highlights the feasibility and safety of these complex surgeries in a community setting.

A single institution experience with robotic and laparoscopic distal pancreatectomies

Shi Qing Lee,Tousif Kabir,Ye-Xin Koh,Jin-Yao Teo,Ser-Yee Lee,Juinn-Huar Kam,Peng-Chung Cheow,Prema Raj Jeyaraj,Pierce K. H. Chow,London L. Ooi,Alexander Y. F. Chung,Chung-Yip Chan,Brian K. P. Goh 한국간담췌외과학회 2020 Annals of hepato-biliary-pancreatic surgery Vol.24 No.3

Backgrounds/Aims: This study aims to describe our experience with minimally-invasive distal pancreatectomies, with emphasis on the comparison between robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP). Methods: Retrospective review of 102 consecutive RDP and LDP from 2006 to 2019 was performed. Results: There were 27 and 75 patients who underwent RDP and LDP, respectively. There were 12 (11.8%) open conversions and 16 (15.7%) patients had major (>grade 2) morbidities. Patients who underwent RDP had significantly higher rates of splenic preservation (44.4% vs. 13.3%, p=0.002), higher rates of splenic-vessel preservation (40.7% vs. 9.3%, p=0.001), higher median difficulty score (5 vs. 3, p=0.002) but longer operation time (385 vs. 245 minutes, p<0.001). The rate of open conversion tended to be lower with RDP (3.7% vs. 14.7%, p=0.175). Conclusions: In our institution practice, both RDP and LDP were safe and effective. The use of RDP appeared to be complementary to LDP, allowing us to perform more difficult procedures with comparable postoperative outcomes.