Tommaso Giuliani1, Giovanni Marchegiani1, Mark D Girgis2, Stefano Francesco Crinò3, Venkataraman R Muthusamy4, Laura Bernardoni3, Antonio Pea1, Marco Ramera1, Salvatore Paiella1, Luca Landoni5, Armando Gabbrielli3, Roberto Salvia1, Timothy R Donahue2, Claudio Bassi1. 1. Unit of General and Pancreatic Surgery, The Pancreas Institute, University of Verona, Verona Hospital Trust, P.le L.A. Scuro n° 10, 37134, Verona, Italy. 2. Division of Surgical Oncology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA. 3. Unit of Gastroenterology and Digestive Endoscopy, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. 4. Division of Digestive Diseases, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA. 5. Unit of General and Pancreatic Surgery, The Pancreas Institute, University of Verona, Verona Hospital Trust, P.le L.A. Scuro n° 10, 37134, Verona, Italy. Luca.landoni@aovr.veneto.it.
Abstract
BACKGROUND: Pancreatic enucleation (PE) is a viable option for the removal of non-malignant pancreatic masses leading to complete preservation of organ function. Nevertheless, PE is associated with substantial rates of post-operative pancreatic fistula (POPF), particularly when the mass is close to the main pancreatic duct (MPD). Preoperative stenting of the MPD may prevent its injury when performing PE. This paper describes a novel technique of "deep" PE preceded by endoscopic stenting of the MPD. METHODS: From January 2017 to May 2019, patients with small pancreatic neuroendocrine tumors proximal to the MPD were candidates for PE with previous stenting of the MPD at the University of Verona, Italy, and at the UCLA Medical Center, Los Angeles, California. The endoscopic stenting was scheduled either the day before or 3 weeks before surgery, depending on the participating institute. RESULTS: Ten patients were included in this pilot study. The endoscopic procedure was successful and well tolerated in all cases. Open, laparoscopic and robotic PE were performed. Seven patients had surgical complications. Among these, six developed a post-operative pancreatic fistula (POPF), but neither grade C fistulas nor disruptions of the MPD were detected. At pathology, a low grade pancreatic neuroendocrine tumor was confirmed in all cases. CONCLUSION: In the setting of high-volume centers, this procedure is safe, and it is associated with acceptable short-term surgical morbidity. The preoperative stenting of the MPD might extend the surgical indications for PE.
BACKGROUND:Pancreatic enucleation (PE) is a viable option for the removal of non-malignant pancreatic masses leading to complete preservation of organ function. Nevertheless, PE is associated with substantial rates of post-operative pancreatic fistula (POPF), particularly when the mass is close to the main pancreatic duct (MPD). Preoperative stenting of the MPD may prevent its injury when performing PE. This paper describes a novel technique of "deep" PE preceded by endoscopic stenting of the MPD. METHODS: From January 2017 to May 2019, patients with small pancreatic neuroendocrine tumors proximal to the MPD were candidates for PE with previous stenting of the MPD at the University of Verona, Italy, and at the UCLA Medical Center, Los Angeles, California. The endoscopic stenting was scheduled either the day before or 3 weeks before surgery, depending on the participating institute. RESULTS: Ten patients were included in this pilot study. The endoscopic procedure was successful and well tolerated in all cases. Open, laparoscopic and robotic PE were performed. Seven patients had surgical complications. Among these, six developed a post-operative pancreatic fistula (POPF), but neither grade C fistulas nor disruptions of the MPD were detected. At pathology, a low grade pancreatic neuroendocrine tumor was confirmed in all cases. CONCLUSION: In the setting of high-volume centers, this procedure is safe, and it is associated with acceptable short-term surgical morbidity. The preoperative stenting of the MPD might extend the surgical indications for PE.
Authors: C E Cauley; H A Pitt; K M Ziegler; A Nakeeb; C M Schmidt; N J Zyromski; M G House; K D Lillemoe Journal: J Gastrointest Surg Date: 2012-04-24 Impact factor: 3.452
Authors: Anneke P J Jilesen; Casper H J van Eijck; K H in't Hof; S van Dieren; Dirk J Gouma; Els J M Nieveen van Dijkum Journal: World J Surg Date: 2016-03 Impact factor: 3.352
Authors: Giuseppe Iabichino; Milena Di Leo; Monica Arena; Giovanni Giuseppe Rubis Passoni; Elisabetta Morandi; Francesca Turpini; Paolo Viaggi; Carmelo Luigiano; Luca De Luca Journal: World J Gastroenterol Date: 2022-09-14 Impact factor: 5.374