Partial pancreatic resection along the embryological fusion plane - no longer a fantasy

The embryological connection between the dorsal and ventral pancreatic regions divides the pancreas into two segments. This anatomical dependence allows segmental pancreatic resection through the embryological fusion plane (EFP). The advantages of limited pancreatic resection are the preservation of the natural continuity and function of the gastrointestinal tract and the avoidance of the metabolic and endocrine consequences of total resection of the pancreas and the duodenum.

Two patients are described who underwent anatomicalsegmentectomyof the pancreatic head along the EFP for the treatment of pancreatic cystic tumor and main duct IPMN. The authors suggested diagnostic and intraoperative management leading to qualification for pancreatic resection along the EFP.

Pancreas and duodenum sparing surgery is an opportunity for patients in terms of the post-operative quality of life. Indications for this kind of surgery are limited and case selection is very difficult. The procedure for embryological bud resection is highly complicated includes a high rate of possible complications. On the other hand high volume centers may offer this procedure at an acceptable rate of complications in selected cases.

Accurate diagnosis with a vascular anatomy and biliary and pancreatic duct configuration give grounds to analyze pancreas-sparing surgery. The operation plan requires careful 3D planning and an experienced team. Bipolar electrocautery, micro surgical tools and intraoperative cholangiography and pancreatography are helpful.