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Clinical outcomes for 14 consecutive patients with solid pseudopapillary neoplasms who underwent laparoscopic distal pancreatectomy
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Abstracts / Pancreatology 16 (2016) S1eS192
F-133. C l i n i c a l o u t c o m e s f o r 14 c o n s e c u t i v e p a t i e n t s w i t h s o l i d pseudopapillary neoplasms who underwent laparoscopic distal pancreatectomy Makoto Kusakabe, Yoshiharu Nakamura, Akira Matsushita, Akira Katsuno, Kazuya Yamahatsu, Hiroki Sumiyoshi, Yoshiaki Mizuguchi, Eiji Uchida Department of Gastrointestinal and Hepato-Billary-Pancreatic Surgery, Nippon Medical School, Japan Introduction: The postoperative results of laparoscopic distal pancreatectomy for solid pseudopapillary neoplasm of the pancreas (SPN), including the effects of spleen-preserving resection, are still to be elucidated. Methods: Of the 139 patients who underwent laparoscopic pancreatectomy for non-cancerous tumors, 14 consecutive patients (average age, 29.6 years;1 man, 13 women) with solitary SPN who underwent laparoscopic distal pancreatectomy between March 2004 and June 2015 were enrolled. The tumors had a mean diameter of 4.8 cm. Laparoscopic spleenpreserving distal pancreatectomy was performed in eight patients (spleenpreserving group), including two cases involving pancreatic tail preservation, and laparoscopic spleno-distal pancreatectomy was performed in six patients (standard resection group). Results: The median operating time was 317 min, and the median blood loss was 50 mL. Postoperatively, grade B pancreatic fistulas appeared in two patients (14.3%) but resolved with conservative treatment. No patients had postoperative complications, other than pancreatic fistulas, or required reoperation. The median postoperative hospital stay was 11 days, and the postoperative mortality was zero. None of the patients had positive surgical margins or lymph nodes with metastasis. The median follow-up period did not significantly differ between the two groups (20 vs 39 months, P¼0.1368). All of the patients are alive and free from recurrent tumors without major latephase complications. Conclusion: Laparoscopic distal pancreatectomy might be a suitable treatment for patients with SPN. A spleen-preserving operation is preferable for younger patients with SPN, and this study demonstrated the noninferiority of the procedure compared to spleno-distal pancreatectomy.
F-134. The surgical techniques of laparoscopic pancreaticoduodenectomy aiming at safety Akira Matsushita, Yoshiharu Nakamura, Akira Katsuno, Hiroki Sumiyoshi, Kazuya Yamahatsu, Eiji Uchida
of the ligament Treitz, we dissect the transverse mesocolon and then we dissect the mesojejunum and the mesopancreas through the mesocolon from left side of the SMA as recognizing the position of both pancreatic body and SMA in the same view field (laparoscopic trans-mesocolic approach). Consequently, we can widen the mesopancreas and the nerve plexus between the uncinate process and the SMA and we safely dissect them without misconception. Conclusion: By using this procedure, we can easily recognize the SMA in Lap-PD. We also use this procedure in open PD.
F-135. Time-dependent changes after ethanol injection into the pancreas: A experimental study using a porcine model Kazuyuki Matsumoto 1, Hironari Kato 1, Koichiro Tsutsumi 1, Soichiro Fushimi 2, Shinsuke Oda 2, Sho Mizukawa 1, Syuntaro Yabe 1, Hiroyuki Seki 1, Yutaka Akimoto 1, Daisuke Uchida 1, Takeshi Tomoda 1, Naoki Yamamoto 1, Shigeru Horiguchi 1, Hiroyuki Okada 1 1 Department of Gastroenterology ＆ Hepatology, Okayama University, Japan 2 Department of Pathology, Okayama University, Japan
Background: Ethanol has been used to successfully ablate cystic and solid lesions in the pancreas.This study aimed to investigate the effects of an ethanol injection into the pancreas of pigs and observe time-dependent changes in images of the pancreatic parenchyma. Methods: Pure ethanol was injected into the pancreatic tail using a 25G EUS needle with direct ultrasound guidance:1.0 ml and 2.0 ml was injected, respectively. MRI was performed before the procedure, immediately after, and on postoperative day (POD) 7. Blood samples were taken before the procedure and on POD 1, 3, 5, and 7. Pigs were euthanized on POD 7. Results: Immediately after the injection, linear high signal areas in the pancreatic tail were noted in both animals on T2 images, measuring 3532 mm in the 1.0 ml-injected pig and 4238mm in the 2.0 ml-injected pig. After POD 7, rounded high signal areas were noted on T2 images, measuring 2218 mm and 3628 mm, respectively. On POD 1, the pig receiving 1 ml of ethanol had a 53% elevation in serum amylase while the pig receiving 2 ml of ethanol had a 66% elevation. Histologically, cystic and necrotic changes in the parenchyma were observed, measuring 2322 mm in the 1.0 mlinjected pig and 4035 mm in the 2.0-ml injected pig. Conclusions: The injected ethanol immediately spread around the pancreatic parenchyma. Thereafter necrosis, cystic changes and inflammation occurred around the injected area. MRI could correctly evaluate the ethanol ablation area.
Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Japan Introduction: The recent advances of surgical techniques and technology allow minimally invasive surgery to be applied in patients with diseases of the pancreatic lesion. Improved visualization of laparoscopy enables precise dissection using forceps and all member of the surgical team can share the same visual field in laparoscopic surgery. But laparoscopic surgery is sometimes more difficult compared with open surgery, in part because surgeons must operate in a three-dimensional space through a two-dimensional (2D) vision, which results in loss of depth perception. It is important to create the good operative field in laparoscopic surgery. From January 2004 to December 2015, we had experienced 230 cases of laparoscopic pancreatectomy including 60 cases of laparoscopic pancreaticoduodenectomy (Lap-PD) at Nippon Medical School, following the approval of the hospital's Ethics Review Board. We report how to make the operative field around the superior mesenteric artery (SMA) in Lap-PD. Method: In the uncinate process of the pancreas, the mesopancreas, the mesocolon, the mesoduodenum, the mesojejunum and the nerve plexus around the SMA lie on top of one another. By separately exposing each mesenteriolum and nerve plexus, we can create a wide surgical field. It results in avoiding misguided dissection due to 2-D vision. After dissection
F-136. The role of Smad2/3 linker phosphorylation in the regenerative phase of acute pancreatitis Masayuki Sakao, Kazuichi Okazaki, Kazushige Uchida, Akiyoshi Nishio, Toshiro Fukui Third Department of Internal Medicine, Kansai Medical University, Japan Introduction: In our previous report, we showed that, in small intestines and other organs, pSmad2/3L-Thr immunostaining-positive cells were detected in specific epithelial cells where the respective putative stem cells are thought to exist. We observed pSmad2,3L-Thr expression in pancreas to elucidate the location of stem/progenitor cells in the pancreas after caerulein-induced pancreatitis. Aims & methods: Male C57BL/6 mice received 7times hourly intraperitoneal injections of caerulein. Pancreatitis-affected tissue sections were immunostained for pSmad2,3L-Thr with CD133, PDX-1, Ngn3, SOX9, and
Abstracts / Pancreatology 16 (2016) S1eS192
F-133. C l i n i c a l o u t c o m e s f o r 14 c o n s e c u t i v e p a t i e n t s w i t h s o l i d pseudopapillary neoplasms who underwent laparoscopic distal pancreatectomy Makoto Kusakabe, Yoshiharu Nakamura, Akira Matsushita, Akira Katsuno, Kazuya Yamahatsu, Hiroki Sumiyoshi, Yoshiaki Mizuguchi, Eiji Uchida Department of Gastrointestinal and Hepato-Billary-Pancreatic Surgery, Nippon Medical School, Japan Introduction: The postoperative results of laparoscopic distal pancreatectomy for solid pseudopapillary neoplasm of the pancreas (SPN), including the effects of spleen-preserving resection, are still to be elucidated. Methods: Of the 139 patients who underwent laparoscopic pancreatectomy for non-cancerous tumors, 14 consecutive patients (average age, 29.6 years;1 man, 13 women) with solitary SPN who underwent laparoscopic distal pancreatectomy between March 2004 and June 2015 were enrolled. The tumors had a mean diameter of 4.8 cm. Laparoscopic spleenpreserving distal pancreatectomy was performed in eight patients (spleenpreserving group), including two cases involving pancreatic tail preservation, and laparoscopic spleno-distal pancreatectomy was performed in six patients (standard resection group). Results: The median operating time was 317 min, and the median blood loss was 50 mL. Postoperatively, grade B pancreatic fistulas appeared in two patients (14.3%) but resolved with conservative treatment. No patients had postoperative complications, other than pancreatic fistulas, or required reoperation. The median postoperative hospital stay was 11 days, and the postoperative mortality was zero. None of the patients had positive surgical margins or lymph nodes with metastasis. The median follow-up period did not significantly differ between the two groups (20 vs 39 months, P¼0.1368). All of the patients are alive and free from recurrent tumors without major latephase complications. Conclusion: Laparoscopic distal pancreatectomy might be a suitable treatment for patients with SPN. A spleen-preserving operation is preferable for younger patients with SPN, and this study demonstrated the noninferiority of the procedure compared to spleno-distal pancreatectomy.
F-134. The surgical techniques of laparoscopic pancreaticoduodenectomy aiming at safety Akira Matsushita, Yoshiharu Nakamura, Akira Katsuno, Hiroki Sumiyoshi, Kazuya Yamahatsu, Eiji Uchida
of the ligament Treitz, we dissect the transverse mesocolon and then we dissect the mesojejunum and the mesopancreas through the mesocolon from left side of the SMA as recognizing the position of both pancreatic body and SMA in the same view field (laparoscopic trans-mesocolic approach). Consequently, we can widen the mesopancreas and the nerve plexus between the uncinate process and the SMA and we safely dissect them without misconception. Conclusion: By using this procedure, we can easily recognize the SMA in Lap-PD. We also use this procedure in open PD.
F-135. Time-dependent changes after ethanol injection into the pancreas: A experimental study using a porcine model Kazuyuki Matsumoto 1, Hironari Kato 1, Koichiro Tsutsumi 1, Soichiro Fushimi 2, Shinsuke Oda 2, Sho Mizukawa 1, Syuntaro Yabe 1, Hiroyuki Seki 1, Yutaka Akimoto 1, Daisuke Uchida 1, Takeshi Tomoda 1, Naoki Yamamoto 1, Shigeru Horiguchi 1, Hiroyuki Okada 1 1 Department of Gastroenterology ＆ Hepatology, Okayama University, Japan 2 Department of Pathology, Okayama University, Japan
Background: Ethanol has been used to successfully ablate cystic and solid lesions in the pancreas.This study aimed to investigate the effects of an ethanol injection into the pancreas of pigs and observe time-dependent changes in images of the pancreatic parenchyma. Methods: Pure ethanol was injected into the pancreatic tail using a 25G EUS needle with direct ultrasound guidance:1.0 ml and 2.0 ml was injected, respectively. MRI was performed before the procedure, immediately after, and on postoperative day (POD) 7. Blood samples were taken before the procedure and on POD 1, 3, 5, and 7. Pigs were euthanized on POD 7. Results: Immediately after the injection, linear high signal areas in the pancreatic tail were noted in both animals on T2 images, measuring 3532 mm in the 1.0 ml-injected pig and 4238mm in the 2.0 ml-injected pig. After POD 7, rounded high signal areas were noted on T2 images, measuring 2218 mm and 3628 mm, respectively. On POD 1, the pig receiving 1 ml of ethanol had a 53% elevation in serum amylase while the pig receiving 2 ml of ethanol had a 66% elevation. Histologically, cystic and necrotic changes in the parenchyma were observed, measuring 2322 mm in the 1.0 mlinjected pig and 4035 mm in the 2.0-ml injected pig. Conclusions: The injected ethanol immediately spread around the pancreatic parenchyma. Thereafter necrosis, cystic changes and inflammation occurred around the injected area. MRI could correctly evaluate the ethanol ablation area.
Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Japan Introduction: The recent advances of surgical techniques and technology allow minimally invasive surgery to be applied in patients with diseases of the pancreatic lesion. Improved visualization of laparoscopy enables precise dissection using forceps and all member of the surgical team can share the same visual field in laparoscopic surgery. But laparoscopic surgery is sometimes more difficult compared with open surgery, in part because surgeons must operate in a three-dimensional space through a two-dimensional (2D) vision, which results in loss of depth perception. It is important to create the good operative field in laparoscopic surgery. From January 2004 to December 2015, we had experienced 230 cases of laparoscopic pancreatectomy including 60 cases of laparoscopic pancreaticoduodenectomy (Lap-PD) at Nippon Medical School, following the approval of the hospital's Ethics Review Board. We report how to make the operative field around the superior mesenteric artery (SMA) in Lap-PD. Method: In the uncinate process of the pancreas, the mesopancreas, the mesocolon, the mesoduodenum, the mesojejunum and the nerve plexus around the SMA lie on top of one another. By separately exposing each mesenteriolum and nerve plexus, we can create a wide surgical field. It results in avoiding misguided dissection due to 2-D vision. After dissection
F-136. The role of Smad2/3 linker phosphorylation in the regenerative phase of acute pancreatitis Masayuki Sakao, Kazuichi Okazaki, Kazushige Uchida, Akiyoshi Nishio, Toshiro Fukui Third Department of Internal Medicine, Kansai Medical University, Japan Introduction: In our previous report, we showed that, in small intestines and other organs, pSmad2/3L-Thr immunostaining-positive cells were detected in specific epithelial cells where the respective putative stem cells are thought to exist. We observed pSmad2,3L-Thr expression in pancreas to elucidate the location of stem/progenitor cells in the pancreas after caerulein-induced pancreatitis. Aims & methods: Male C57BL/6 mice received 7times hourly intraperitoneal injections of caerulein. Pancreatitis-affected tissue sections were immunostained for pSmad2,3L-Thr with CD133, PDX-1, Ngn3, SOX9, and