open access

Vol 79, No 3 (2020)
CASE REPORTS
Published online: 2019-11-15
Submitted: 2019-09-09
Accepted: 2019-10-05
Get Citation

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

M. Łącka, D. Łaski, S. Hać, M. Szymański
DOI: 10.5603/FM.a2019.0121
·
Pubmed: 31750540
·
Folia Morphol 2020;79(3):640-644.

open access

Vol 79, No 3 (2020)
CASE REPORTS
Published online: 2019-11-15
Submitted: 2019-09-09
Accepted: 2019-10-05

Abstract

Background: 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.

Materials and methods: Two patients are described who underwent anatomical segmentectomy of the pancreatic head along the EFP for the treatment of pancreatic cystic tumour and main duct intraductal papillary-mucinous neoplasm. The authors suggested diagnostic and intraoperative management leading to qualification for pancreatic resection along the EFP.

Results: 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 centres may offer this procedure at an acceptable rate of complications in selected cases.

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

Abstract

Background: 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.

Materials and methods: Two patients are described who underwent anatomical segmentectomy of the pancreatic head along the EFP for the treatment of pancreatic cystic tumour and main duct intraductal papillary-mucinous neoplasm. The authors suggested diagnostic and intraoperative management leading to qualification for pancreatic resection along the EFP.

Results: 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 centres may offer this procedure at an acceptable rate of complications in selected cases.

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

Get Citation

Keywords

intraductal papillary-mucinous neoplasm; pancreas segmentectomy; pancreatic sparing resection

About this article
Title

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

Journal

Folia Morphologica

Issue

Vol 79, No 3 (2020)

Pages

640-644

Published online

2019-11-15

DOI

10.5603/FM.a2019.0121

Pubmed

31750540

Bibliographic record

Folia Morphol 2020;79(3):640-644.

Keywords

intraductal papillary-mucinous neoplasm
pancreas segmentectomy
pancreatic sparing resection

Authors

M. Łącka
D. Łaski
S. Hać
M. Szymański

References (15)
  1. Chunfu Z, Zhongzhi J, Xudong Z, et al. Anatomical segmentectomy of the pancreatic head along the embryological fusion plane: a case series and a literature review. Medicine. 2018; 18: e0623.
  2. Iacono C, Ruzzenente A, Conci S, et al. Head dorsal pancreatectomy: an alternative to the pancreaticoduodenectomy for not enucleable benign or low-grade malignant lesions. Pancreatology. 2014; 14(5): 419–424.
  3. Kimura W. Surgical anatomy of the pancreas for limited resection. J Hepatobiliary Pancreat Surg. 2000; 7(5): 473–479.
  4. Nakagohri T, Kinoshita T, Konishi M, et al. Inferior head resection of the pancreas for intraductal papillary mucinous neoplasms. J Hepatobiliary Pancreat Sci. 2010; 17(6): 798–802.
  5. Nishi T, Kawabata Y, Ishikawa N, et al. Intraductal papillary mucinous carcinoma of the pancreas associated with pancreas divisum: a case report and review of the literature. BMC Gastroenterol. 2015; 15: 78.
  6. Ohwada S, Ogawa T, Kasahara M, et al. Ventral pancreas-preserving pancreatic head and body resection. Hepatogastroenterology. 2001; 48(42): 1622–1624.
  7. Ryu M, Takayama W, Watanabe K, et al. Ventral pancreatic resection for adenoma and low-grade malignancies of the head of the pancreas. Surg Today. 1996; 26(7): 476–481.
  8. Sakamoto Y, Nagai M, Tanaka N, et al. Anatomical segmentectomy of the head of the pancreas along the embryological fusion plane: a feasible procedure? Surgery. 2000; 128(5): 822–831.
  9. Scatton O, Sauvanet A, Cazals-Hatem D, et al. Dorsal pancreatectomy: an embryology-based resection. J Gastrointest Surg. 2006; 10(3): 434–438.
  10. Skandalakis L, Rowe J, Gray S, et al. Surgical embryology and anatomy of the pancreas. Surg Clin North Am. 1993; 73(4): 661–697.
  11. Talbot ML, Foulis AK, Imrie CW. Total dorsal pancreatectomy for intraductal papillary mucinous neoplasm in a patient with pancreas divisum. Pancreatology. 2005; 5(2-3): 285–288.
  12. Thayer SP, Fernández-del Castillo C, Balcom JH, et al. Complete dorsal pancreatectomy with preservation of the ventral pancreas: a new surgical technique. Surgery. 2002; 131(5): 577–580.
  13. Uchida T, Takada T, Ammori BJ, et al. Three-dimensional reconstruction of the ventral and dorsal pancreas: a new insight into anatomy and embryonic development. J Hepatobiliary Pancreat Surg. 1999; 6(2): 176–180.
  14. Wang X, Tan CL, Song HY, et al. Duodenum and ventral pancreas preserving subtotal pancreatectomy for low-grade malignant neoplasms of the pancreas: An alternative procedure to total pancreatectomy for low-grade pancreatic neoplasms. World J Gastroenterol. 2017; 23(35): 6457–6466.
  15. Yu-Wen T, Rey-Heng Hu, Ji-Shiang H, et al. Noninvasive pancreatic cystic neoplasms can be safely and effectively treated by limited pancreatectomy. Ann Surg Oncol. 2008; 15(1): 193–198.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By  "Via Medica sp. z o.o." sp.k., Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl