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Endoscopic placement of pancreatic stent for “Deep” pancreatic enucleations operative technique and preliminary experience at two high-volume centers

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Abstract

Background

Pancreatic enucleation (PE) is a viable option for the removal of non-malignant pancreatic masses leading to complete preservation of organ function. Nevertheless, PE is associated with substantial rates of post-operative pancreatic fistula (POPF), particularly when the mass is close to the main pancreatic duct (MPD). Preoperative stenting of the MPD may prevent its injury when performing PE. This paper describes a novel technique of “deep” PE preceded by endoscopic stenting of the MPD.

Methods

From January 2017 to May 2019, patients with small pancreatic neuroendocrine tumors proximal to the MPD were candidates for PE with previous stenting of the MPD at the University of Verona, Italy, and at the UCLA Medical Center, Los Angeles, California. The endoscopic stenting was scheduled either the day before or 3 weeks before surgery, depending on the participating institute.

Results

Ten patients were included in this pilot study. The endoscopic procedure was successful and well tolerated in all cases. Open, laparoscopic and robotic PE were performed. Seven patients had surgical complications. Among these, six developed a post-operative pancreatic fistula (POPF), but neither grade C fistulas nor disruptions of the MPD were detected. At pathology, a low grade pancreatic neuroendocrine tumor was confirmed in all cases.

Conclusion

In the setting of high-volume centers, this procedure is safe, and it is associated with acceptable short-term surgical morbidity. The preoperative stenting of the MPD might extend the surgical indications for PE.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Unit of General and Pancreatic Surgery, The Pancreas Institute, University of Verona, Verona Hospital Trust, P.le L.A. Scuro n° 10, 37134, Verona, Italy

    Tommaso Giuliani, Giovanni Marchegiani, Antonio Pea, Marco Ramera, Salvatore Paiella, Luca Landoni, Roberto Salvia & Claudio Bassi

  2. Unit of Gastroenterology and Digestive Endoscopy, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy

    Stefano Francesco Crinò, Laura Bernardoni & Armando Gabbrielli

  3. Division of Surgical Oncology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA

    Mark D. Girgis & Timothy R. Donahue

  4. Division of Digestive Diseases, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA

    Venkataraman R. Muthusamy

Authors
  1. Tommaso Giuliani
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  2. Giovanni Marchegiani
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  14. Claudio Bassi
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Contributions

MG and GT designed the study; all authors performed the data collection; MG, CSF, GM and GT wrote the paper; LL, SR, DT and BC revised the paper.

Corresponding author

Correspondence to Luca Landoni.

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Tommaso Giuliani, Giovanni Marchegiani, Mark D. Girgis, Stefano Francesco Crinò, Venkataraman R. Muthusamy, Laura Bernardoni, Antonio Pea, Marco Ramera, Salvatore Paiella, Luca Landoni, Armando Gabbrielli, Roberto Salvia, Timothy R. Donahue and Claudio Bassi have no conflict of interest or financial ties to disclose.

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Giuliani, T., Marchegiani, G., Girgis, M.D. et al. Endoscopic placement of pancreatic stent for “Deep” pancreatic enucleations operative technique and preliminary experience at two high-volume centers. Surg Endosc 34, 2796–2802 (2020). https://doi.org/10.1007/s00464-020-07501-y

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