Laparoscopic Duodenum and Spleen-Preserving Subtotal or Total Pancreatectomy: A Parenchyma-Sparing Strategy for Main Duct Intraductal Papillary Mucinous Neoplasms (with Video)

Zheng Li ^1,2,3,4, Yihua Shi ^1,2,3,4, Wenjie Tang ^1,2,3,4,5

¹Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
²Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
³Shanghai Pancreatic Cancer Institute, Shanghai, China.
⁴Pancreatic Cancer Institute, Fudan University, Shanghai, China.
⁵Department of Nursing Administration, Fudan University Shanghai Cancer Center, Shanghai, China.
⁶Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China. zhouchenjie@fudanpci.org.
⁷Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. zhouchenjie@fudanpci.org.
⁸Shanghai Pancreatic Cancer Institute, Shanghai, China. zhouchenjie@fudanpci.org.
⁹Pancreatic Cancer Institute, Fudan University, Shanghai, China. zhouchenjie@fudanpci.org.
¹⁰Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China. yuxianjun@fudanpci.org.
¹¹Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. yuxianjun@fudanpci.org.
¹²Shanghai Pancreatic Cancer Institute, Shanghai, China. yuxianjun@fudanpci.org.
¹³Pancreatic Cancer Institute, Fudan University, Shanghai, China. yuxianjun@fudanpci.org.
¹⁴Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China. xuxiaowu@fudanpci.org.
¹⁵Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. xuxiaowu@fudanpci.org.
¹⁶Shanghai Pancreatic Cancer Institute, Shanghai, China. xuxiaowu@fudanpci.org.
¹⁷Pancreatic Cancer Institute, Fudan University, Shanghai, China. xuxiaowu@fudanpci.org.

⁰Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.

Annals of Surgical Oncology +

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September 23, 2024

View abstract on PubMed

Summary

Laparoscopic spleen-preserving pancreatectomy offers a safe and feasible parenchyma-sparing approach for premalignant main duct intraductal papillary mucinous neoplasms (MD-IPMN). This technique minimizes pancreatic functional impairment while preserving vital organs.

Area Of Science

Surgical Oncology
Gastroenterology
Minimally Invasive Surgery

Background

Premalignant main duct intraductal papillary mucinous neoplasms (MD-IPMN) require effective surgical management.
Parenchyma-sparing pancreatectomy aims to preserve pancreatic function.

Purpose Of The Study

To propose patient selection strategies for laparoscopic duodenum and spleen-preserving subtotal or total pancreatectomy (LDSP-STP/TP).
To provide a comprehensive overview of the LDSP-STP/TP technique for MD-IPMN.

Main Methods

Development of patient selection criteria based on imaging, family history, genomics, and intraoperative findings.
Step-by-step description of the LDSP-STP/TP surgical technique.
Performed a total of six procedures (five LDSP-STP, one LDSP-TP).

Main Results

Successful selective resection of affected pancreatic parenchyma, preserving the duodenum, CBD, spleen, and associated vessels.
Operation times ranged from 295-495 minutes with blood loss of 100-300 mL.
All patients experienced low-grade dysplasia, resumed eating within 3-5 days, and had Clavien-Dindo grade I complications. No CBD or splenic ischemia or pseudocyst formation at 3-month follow-up. Satisfactory glycemic control was observed in patients undergoing LDSP-STP.

Conclusions

LDSP-STP/TP is technically feasible and safe for MD-IPMN.
The technique allows selective pancreatic resection, minimizing functional impairment.
Long-term prospective validation is necessary to confirm these findings.

Keywords:

Duodenum and spleen-preserving pancreatectomy Intraductal papillary mucinous neoplasms Laparoscopic surgical technique Main pancreatic duct Prognosis