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

Publisher: Springer Country of Publication: United States NLM ID: 9420840 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1534-4681 (Electronic) Linking ISSN: 10689265 NLM ISO Abbreviation: Ann Surg Oncol Subsets: MEDLINE

Publication: 2005- : New York, NY : Springer
Original Publication: New York, NY : Raven Press, c1994-

Pancreatectomy*/methods ; Laparoscopy*/methods ; Spleen*/surgery ; Spleen*/pathology ; Pancreatic Neoplasms*/surgery ; Pancreatic Neoplasms*/pathology ; Organ Sparing Treatments*/methods ; Pancreatic Intraductal Neoplasms*/surgery ; Pancreatic Intraductal Neoplasms*/pathology; Humans ; Female ; Male ; Middle Aged ; Duodenum/surgery ; Duodenum/pathology ; Aged ; Carcinoma, Pancreatic Ductal/surgery ; Carcinoma, Pancreatic Ductal/pathology ; Prognosis ; Follow-Up Studies ; Adenocarcinoma, Mucinous/surgery ; Adenocarcinoma, Mucinous/pathology

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.
(© 2024. The Author(s).)

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2019-01-07-00-07-E00057 Scientific Innovation Project of Shanghai Education Committee; SHDC2020CR1006A Clinical Research Plan of Shanghai Hospital Development Center; 20224Z0006 Excellence Project of Shanghai Municipal Health Commission; 22YF1409000 Sailing Project of Science and Technology Commission of Shanghai Municipality; 21JC1401500 Shanghai Municipal Science and Technology Major Project; 20234Y0119 Clinical Research Project of Health Industry of Shanghai Municipal Health Commission

Keywords: Duodenum and spleen-preserving pancreatectomy; Intraductal papillary mucinous neoplasms; Laparoscopic surgical technique; Main pancreatic duct; Prognosis

Date Created: 20240923 Date Completed: 20241109 Latest Revision: 20241111

20241114

PMC11549168

10.1245/s10434-024-16244-2

39312053