Unraveling Pancreatic Segmentation

Area of Science:

• Surgical anatomy
• Gastroenterology
• Surgical oncology

Background:

• Limited pancreatic resections are increasing, but associated with higher postoperative fistula rates.
• Pancreatic segmentation aims to improve surgical precision by identifying distinct anatomical portions.
• The goal is to reduce fistula rates by enabling targeted removal of pancreatic segments with their own ducts.

Purpose of the Study:

• To systematically review existing pancreatic segmentation theories.
• To discuss the relevance and limitations of these segmentation methodologies.
• To assess their impact on reducing postoperative fistula rates.

Main Methods:

• A comprehensive search of the PubMed database was conducted.
• Articles investigating pancreatic segmentation in human or animal anatomy, cadaveric, or surgical studies were included.
• Selected articles were grouped by segmentation methodology: anatomic, vascular, embryologic, and lymphatic.

Main Results:

• 47 out of 99 articles were selected and analyzed.
• Existing theories (anatomic, vascular, embryologic, lymphatic) lack distinct borders and surgical applicability.
• No significant decrease in postoperative fistula rates was observed when resections followed these segmentation theories.

Conclusions:

• Current pancreatic segmentation theories are insufficient for defining practical anatomical-surgical segments.
• Further research should explore alternative approaches, particularly focusing on pancreatic duct anatomy.
• Embryological 3D modeling and pancreatic duct reconstructions are potential future directions.