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.
Division of Surgical Oncology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
Surg Endosc. 2020 Jun;34(6):2796-2802. doi: 10.1007/s00464-020-07501-y. Epub 2020 Mar 16.
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.
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.
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.
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.
胰腺剜除术（PE）是一种可行的选择，可以切除非恶性胰腺肿块，从而完全保留器官功能。然而，PE 与术后胰瘘（POPF）的发生率较高相关，特别是当肿块靠近主胰管（MPD）时。在进行 PE 之前对 MPD 进行术前支架置入术可能会防止其损伤。本文描述了一种在进行“深部”PE 之前对 MPD 进行内镜支架置入的新方法。
从 2017 年 1 月到 2019 年 5 月，意大利维罗纳大学和加利福尼亚州洛杉矶 UCLA 医疗中心的患者因靠近 MPD 的小胰腺神经内分泌肿瘤而成为 PE 的候选者，这些患者在术前对 MPD 进行了支架置入。内镜支架置入术可根据参与的机构在手术前一天或 3 周前进行。
这项初步研究共纳入 10 例患者。所有病例内镜手术均成功且耐受良好。开放、腹腔镜和机器人 PE 均进行。7 例患者发生手术并发症。其中，6 例发生术后胰瘘（POPF），但未发现 C 级瘘或 MPD 破裂。病理检查证实所有病例均为低度胰腺神经内分泌肿瘤。
在高容量中心，该手术是安全的，且短期手术发病率可接受。MPD 的术前支架置入可能会扩大 PE 的手术适应证。
