Postoperative Outcomes of Distal Pancreatectomy for Retroperitoneal Sarcoma Abutting the Pancreas in the Left Upper Quadrant

BackgroundEn bloc resection of the tumor with adjacent organs is recommended for localized retroperitoneal sarcoma (RPS). However, resection of the pancreas is controversial because it may cause serious complications, such as pancreatic fistula or bleeding. Thus, we evaluated the outcomes of distal pancreatectomy (DP) in pancreas-abutting RPS of the left upper quadrant (LUQ).MethodsWe retrospectively reviewed all consecutive patients who underwent surgery for RPS between September 2001 and April 2020. We selected 150 patients with all or part of their tumor located in the LUQ on preoperative computed tomography. Eighty-six patients who had tumors abutting the pancreas were finally enrolled in our study.ResultsFifty-three patients (53/86; 61.6%) were included in the non-DP group, and 33 patients (33/86; 38.4%) were included in the DP group. Total postoperative complications and complication rates for those Clavien–Dindo grade 3 or higher were similar between the non-DP group and DP group (p = 0.290 and p = 0.550). In the DP group, grade B pancreatic fistulae occurred in 18.2% (6/33) of patients, but grade C pancreatic fistulae were absent, and microscopic pancreatic invasion was noted in 42.4% (14/33) of patients. During multivariate analysis, microscopic pancreatic invasion was deemed a risk factor for local recurrence (p = 0.029). However, there were no significant differences on preoperative computed tomography findings between the pancreatic invasion and non-invasion groups.ConclusionDP is a reasonable procedure for pancreas-abutting RPS located at the LUQ when both complications and complete resection are considered.

Isolated Pancreatic Injury Diagnosed Seven Months After Thoracoabdominal Trauma

We present a case of a closed thoracoabdominal trauma with pancreatic rupture. Closed abdominal trauma is one of the main causes for urgent hospitalization and emergency surgery. Injury of pancreatic ductal system is noted for the most severe course because of complications caused by outflow of the pancreatic juice into the retroperitoneal fat and the free abdominal cavity. One of the main factors affecting the efficacy of treatment is the time gap between a traumatic incident and hospitalization with subsequent surgical treatment. We report the results of management of a 53-year-old patient with closed thoracoabdominal injury and incomplete rupture of the pancreas, diagnosed 6 months after the “steering wheel” trauma. The injury was diagnosed with radiation techniques. Surgery included laparotomy, corporocaudal resection of the pancreas with splenectomy. The incidence of pancreatic traumatic injuries and the results of treatment are the matters for discussion.

Experience in surgical treatment of diseases of the pancreas in children

The article is devoted to the experience of surgical treatment of pathology of the pancreas at the Center for the Treatment of Developmental Anomalies and Diseases of the Hepatopancreatobiliary System in Children on the basis of the Children’s City Clinical Hospital No. 13 named after NF Filatova: annular pancreas, acute and chronic pancreatitis, tumors and cysts of the pancreas. From 2016 to 2020, more than 267 reconstructive interventions on the pancreas were performed, including longitudinal and transverse pancreatojejunoanastamosis, pancreatoduodenal resection, cystoenteroanastamosis, sectoral and total resection of the pancreas. In the postoperative period, the most severe complication in this category of patients was arrosive bleeding, which is the main cause of all deaths after surgery.

Significance of sarcopenia in the development of postoperative complications in patients after pancreas resection

The aim of the research. To evaluate the effect of sarcopenia on the incidence of postoperative complications in patients who underwent resection interventions on the pancreas, as well as the development of a simple clinical diagnosis of sarcopenia. Material and methods. Th e study included 109 patients, including 59 (54.1 %) men and 50 (45.9 %) women. All patients included in the study were operated on with subsequent morphological examination of the removed preparations. Diagnosis of the presence of sarcopenia in a patient was carried out using computed tomography (CT) and calculating the musculoskeletal index. Also, all patients underwent calculation of the psoas major muscle index (IBPM) equal to the ratio of the area of the psoas major muscle on one side to the square of the patient’s height. Th e patients were divided into two groups. The control group (68 patients) included patients without sarcopenia. The main group consisted of 41 patients who were diagnosed with sarcopenia. Results. Among patients in the compared groups, there were no statistically signifi cant diff erences in age, sex, ASA score and body mass index. Th ere was no statistically signifi cant diff erence in the incidence of major complications (Clavien-Dindo III / IV) (p = 0.2), however, the incidence of postoperative infectious complications was signifi cantly higher in patients from the study group compared to the control group (63.4 % versus 39.7 %, respectively, p = 0.01), as well as the incidence of postoperative clinically signifi cant pancreatic fi stulas (36.6 % versus 17.6 %, respectively, p = 0.02), as well as mortality (9.8 % versus 1.5 %, respectively, p = 0.04). The average postoperative bed-day was 19.9±7.8 days in the main group, 14.2±5.1 days in the control group (p = 0.03). According to the study, the value of IBP in the diagnosis of sarcopenia is < 3,5 сm2 /м2 (AUC – 0,83) for men and < 2,7 сm2 /м2 (AUC – 0,87) for women. Conclusion. Sarcopenia is associated with a higher incidence of postoperative infectious complications, clinically signifi cant pancreatic fi stulas, mortality, as well as with a longer postoperative bed-day in patients who underwent resection of the pancreas

Central Pancreatectomy with Roux-en-Y Pancreaticojejunal Anastomosis—Report of Two Cases

Background Central pancreatectomy (CP), a partial resection of the pancreas, is indicated for the excision of neuroendocrine tumors (NETs) of the pancreas, when located at the neck or the proximal body. Specifically, CP is preferable in functional NET and in nonfunctional sized 1 to 2 cm or/with proliferation marker Ki67 < 20% (Grade I/II). Postoperative leakage from the remaining pancreas constitutes the most frequent complication of CP (up to 63%). The aim of our study was to share the experience of our center in CP for NET, with pancreaticojejunal anastomosis. Methods In 1 year, we performed CP in two patients, following the aforementioned criteria. They presented with tumor of the body of the pancreas, which was found in random check with computed tomography, with negative hormonal blood tests and they underwent magnetic resonance imaging and endoscopic ultrasound/fine-needle biopsy/pathological examination. Results The patients underwent CP with Roux-en-Y pancreaticojejunal anastomosis of the distal pancreatic stump and jejunal patch of the proximal pancreatic stump. Histological exam revealed NET sized 2.8 cm and 1.45 cm, Grade I and II, respectively. Postoperatively both patients developed small pancreatic leakage, which did not affect their physical condition and stopped after 20 and 30 days. No one needed pancreatic enzymes supplements or developed new-onset diabetes mellitus. Conclusion CP provided adequate, functional remaining pancreatic tissue in both patients. Small leakages were treated conservatively and retreated without septic complications. As a result, CP might be considered as safe and effective technique for pancreatic neck/proximal body NET.

Trauma of the pancreas. A hidden disaster

Due to its anatomical position, traumatic lesions of the pancreas are rare and difficult to diagnose. Diagnosis time is paramount as an increase in duration translates into an increase in morbidity and mortality. Duct lesions are hard to identify on CT, ERCP being the investigation of choice but it is difficult to obtain as it requires highly specialized staff and equipment. Intraoperative macroscopic and palpatory evaluation of the pancreas in a trauma patient should be elective no matter what other lesions are present. The treatment is mainly dictated by this evaluation and is defined as it follows: stage I and II usually require a conservative approach; stage III, IV, and V usually imply resection of the pancreas although recent advances in conservative management have been made through ERCP and pancreatic duct stenting. In these stages, intraoperative evaluation should ensure the ampulla is intact if the head of the pancreas is not resected. Serum amylase and lipase levels do not offer a concrete direction towards a pancreatic lesion. Currently, there is no standard surgical treatment for these stages thus making intraoperative evaluation mandatory. One must remember that post-traumatic pancreatitis exists, which becomes apparent days after the accident.

LAPAROSCOPIC CENTRAL RESECTION OF THE PANCREAS. THE FIRST EXPERIENCE AT THE MOROZOVSKAYA CITY CHILDREN’S CLINICAL HOSPITAL

The central pancreatic resection is a complex organ-preserving surgical intervention used in patients with tumors located in the area of gland body. The laparoscopic access minimizes surgical trauma and shortens patients’ rehabilitation. The publication describes the first experience of laparoscopic central resection of the pancreas in a 13-year-old girl at the Morozovskaya City Children’s Clinical Hospital, Moscow.

Случай дистальной резекции поджелудочной железы совместно со спленэктомией при оперативном вмешательстве по поводу прорастающей в поджелудочную железу опухоли поперечной ободочной кишки

The article presents a case of successful distal resection of the pancreas together with splenectomy during surgery for a tumor of the transverse colon growing into the pancreas in an elderly patient. The main complications after pancreatic surgery are postoperative pancreatic fistulas, in which there is a risk of septic complications, arrosive bleeding, increased length of stay of patients in hospital and increased mortality [1, 12]. The novelty of the proposed invention, lies in the fact that: pancreatojejunoanastomosis is formed at a distance of 30 cm from the Treitz ligament, then enteroenteroanastomosis is formed between the adducting and diverting loops of the small intestine in the type of side – to-side two rows of sutures, the length of the anastomosis is 4 cm, at a distance of 50 cm from the Treitz ligament, to improve the passage of intestinal chime [2]. This method can be implemented in the practice of surgical hospitals.

THE CASE TREATMENT OF CYSTADENOMA OF THE PANCREAS

Summary. Introduction. Cystadenoma of the pancreas is a benign tumor in the form of a cyst of epithelial origin, which in the absence of adequate treatment disrupts the function of the pancreas, due to compression on nearby tissues, and in 3 % of cases regenerates into cystadenocarcinoma. Aim. Present a clinical case of surgical treatment of cystadenoma of the body of the pancreas, while preserving the caudal part of the latter to prevent the possible development of diabetes. Material and methods. Patient M., 72 years old, who was hospitalized in the infectious department of the central district hospital, during ultrasound of the abdominal cavity and peritoneal space revealed a neoplasm of the retroperitoneal space in the body and tail of the pancreas, in connection with which she was transferred to the surgery department. After the appropriate examination, the patient underwent surgery — laparotomy. Removal of a neoplasm of the body of the pancreas. Distal pancreatojejunoanastomosis, entero-enteroanastomosis. Abdominal drainage. Results. The postoperative period was without complications, drainage was removed, sutures were removed for 9-10 days, the wound healed with primary tension. In the section of the drug, there is a capsule with a wall thickness of up to 2.0 mm, which contains mucopurulent masses in the form of flakes. The outer wall of the capsule is covered with joints and vessels, and the inner has a shiny matte surface. The histopathological examination indicates cystadenoma of the pancreas. The choice to form a distal pancreatojejunostomy in contrast to the distal resection of the pancreas was due to the patient’s age and high probability of developing diabetes because it is in the caudal part of the pancreas is the lion’s number of islets of Langerhans. Conclusion. When performing radical surgical interventions on the pancreas in elderly and senile patients, it is necessary to preserve the tissues of the latter, especially the tail, to prevent the development of diabetes.