Takao Ohtsuka1, Yasuhisa Mori2, Kousei Ishigami3, Takaaki Fujimoto2, Yoshihiro Miyasaka2, Kohei Nakata2, Kenoki Ohuchida2, Eishi Nagai2, Yoshinao Oda4, Shuji Shimizu5, Masafumi Nakamura6. 1. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan; Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Hospital, Fukuoka, Japan. Electronic address: takao-o@surg1.med.kyushu-u.ac.jp. 2. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan. 3. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan. 4. Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Japan. 5. Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Hospital, Fukuoka, Japan; International Medical Department, Kyushu University Hospital, Fukuoka, Japan. 6. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan. Electronic address: mnaka@surg1.med.kyushu-u.ac.jp.
Abstract
BACKGROUND: Circumportal pancreas is a rare congenital pancreatic anomaly. The aim of this study was to clarify the clinical characteristics of patients with circumportal pancreases undergoing pancreatectomy. METHODS: The medical records of 508 patients who underwent pancreatectomy were retrospectively reviewed. The prevalence of circumportal pancreas and related anatomical variations were assessed. Surgical procedures and postoperative outcomes were compared in patients with and without circumportal pancreas. RESULTS: Circumportal pancreas was observed in 9 of the 508 patients (1.7%). In all nine patients, the portal vein was completely encircled by the pancreatic parenchyma above the level of the splenoportal junction, and the main pancreatic duct ran dorsal to the portal vein. The rate of variant hepatic artery did not differ significantly in patients with and without circumportal pancreas. Pancreatic fistula developed more frequently in patients with than without circumportal pancreas (44% vs. 14%, p = 0.03), but other clinical parameters did not differ significantly in these two groups. CONCLUSIONS: Despite being rare, circumportal pancreas may increase the risk of postoperative pancreatic fistula in patients undergoing pancreatectomy. However, a prospective, large-cohort study is necessary to determine the real incidence of relevant anatomical variations and the definitive clinical significance of this rare anomaly.
BACKGROUND: Circumportal pancreas is a rare congenital pancreatic anomaly. The aim of this study was to clarify the clinical characteristics of patients with circumportal pancreases undergoing pancreatectomy. METHODS: The medical records of 508 patients who underwent pancreatectomy were retrospectively reviewed. The prevalence of circumportal pancreas and related anatomical variations were assessed. Surgical procedures and postoperative outcomes were compared in patients with and without circumportal pancreas. RESULTS: Circumportal pancreas was observed in 9 of the 508 patients (1.7%). In all nine patients, the portal vein was completely encircled by the pancreatic parenchyma above the level of the splenoportal junction, and the main pancreatic duct ran dorsal to the portal vein. The rate of variant hepatic artery did not differ significantly in patients with and without circumportal pancreas. Pancreatic fistula developed more frequently in patients with than without circumportal pancreas (44% vs. 14%, p = 0.03), but other clinical parameters did not differ significantly in these two groups. CONCLUSIONS: Despite being rare, circumportal pancreas may increase the risk of postoperative pancreatic fistula in patients undergoing pancreatectomy. However, a prospective, large-cohort study is necessary to determine the real incidence of relevant anatomical variations and the definitive clinical significance of this rare anomaly.