Search

Objective: To analyze the short-term efficacy of distal pancreatectomy with en bloc celiac axis resection (DP-CAR) in the treatment of locally advanced pancreatic body or tail cancer and the effect of vascular variation on morbidity after DP-CAR. Methods: A retrospective study was undertaken of 43 cases with pancreatic ductal adenocarcinoma diagnosed by pathological examination in the treatment of DP-CAR. R0 resection, morbidity and mortality were analyzed perioperatively with the effect of vascular variation. Results: R0 resection by DP-CAR was 81.4% in this study with mortality 7.0% and morbidity 45.6%. Eight cases were found with vascular variation. The postoperative morbidity in the group with vascular variation and in the group without vascular variation was 3/8 (37.5%) vs 17/35 (48.5%) and the mortality 1/8 (12.5%) vs 2/35 (5.7%), respectively. There was no significant difference statistically in morbidity and mortality between 2 groups. Conclusions: DP-CAR has the advantage of safety and feasibility. There would be no effect of vascular variation on morbidity after DP-CAR.

Objective: To assess short-term and long-term outcomes following robotic enucleation (REn) of tumors in the proximal pancreas., Background: Despite the advantages of preserving function via pancreatic enucleation, controversies persist, since this can be associated with severe complications, such as clinically relevant postoperative pancreatic fistula, especially when performed near the main pancreatic duct. The safety and efficacy of REn in this context remain largely unknown., Methods: A retrospective analysis was performed of all patients who underwent REn for benign and low-grade malignant neoplasms in the pancreatic head and uncinate process between January 2005 and December 2021. Clinicopathologic, perioperative, and long-term outcomes were compared with a similar open enucleation (OEn) group., Results: Of 146 patients, 92 underwent REn with a zero conversion-to-open rate. REn was superior to OEn in terms of shorter operative time (90.0 minutes vs 120.0 minutes, P<0.001), decreased blood loss (20.0 mL vs 100.0 min, P=0.001), and lower clinically relevant postoperative pancreatic fistula rate (43.5% vs 61.1%, P=0.040). Bile leakage rate, major morbidity, 90-day mortality, and length of hospital stay were comparable between groups. No post-REn grade C POPF or grade IV/V complication was identified. Subgroup analyses for uncinate process tumors and proximity to the main pancreatic duct did not demonstrate inferior postoperative outcomes. In a median follow-up period of 50 months, REn outcomes were comparable to OEn regarding recurrence rate and pancreatic endocrine or exocrine function., Conclusions: REn for pancreatic head and uncinate process tumors improved clinically relevant outcomes without increased major complications compared to OEn, while demonstrating comparable long-term oncological and functional outcomes., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)