Pancreaticogastrostomy for pancreatic body cystic neoplasms: An organ-sparing approach

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InternationalJournalofSurgeryCaseReports76(2020)153–155

ContentslistsavailableatScienceDirect

International

Journal

of

Surgery

Case

Reports

j o ur na l h o m e p a g e :w w w . c a s e r e p o r t s . c o m

Pancreaticogastrostomy

for

pancreatic

body

cystic

neoplasms:

An

organ-sparing

approach

Orhan

Orhan,

Sinan

Carkman,

Ergin

Erginoz

∗

,

Mehmet

Faik

Ozcelik

IstanbulUniversityCerrahpasa,CerrahpasaFacultyofMedicine,Turkey

a

r

t

i

c

l

e

i

n

f

o

Articlehistory: Received26August2020 Receivedinrevisedform 28September2020 Accepted28September2020 Availableonline30September2020

Keywords:

Pancreaticogastrostomy Centralpancreatectomy Pancreascyst

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INTRODUCTION:Surgicalmanagementofpancreaticcystsdifferaccordingtothespeciﬁclocationofthe cystonthepancreas.Cystslocatedonthepancreaticheadrequirearadicalproceduresuchas pancre-aticoduodenectomy(Whippleprocedure).Cystsofthepancreaticbodyortail,however,requiredistal pancreatectomyasthestandardsurgicalapproach.Analternativesurgicalapproachforcystslocatedin themid-pancreasiscentralpancreatectomywithdistalpancreaticogastrostomy.

PRESENTATIONOFCASE:Inthisreport,wepresentacaseofa22-year-oldwomanwithacystlocatedon themid-pancreasconsistentwithasolidpseudopapillaryneoplasia.Centralpancreatectomywithdistal pancreaticogastrostomywasthesurgicaltechniqueofchoiceperformedinthiscase.

DISCUSSION:Centralpancreatectomyhasemergedasanalternativesurgicalapproachtomid-pancreatic cystswhich includes only the removal of a segment of the pancreas, thereby sparing the distal parenchyma.Comparedwiththetraditionalapproach,thistechniqueofpartialresectionofthepancreatic tissueisdesirableduetoitsorgan-sparingfunction.

CONCLUSION:Centralpancreatectomywithdistalpancreaticogastrostomycanbeanalternativetodistal pancreatectomyforcystslocatedinthemid-pancreaticregion.Thisrareprocedurepreventsany unnec-essaryhealthypancreatictissueloss,reducestheriskofdevelopingcomplications,andisanalternative treatmentofchoicetodistalpancreatectomy.

1. Introduction

Cysts and tumors of the pancreascan beproblematic given theirnatureofevolvingintoamalignantlesion.Becauseofthis fact,evensomebenignpancreaticcystsrequiresurgical interven-tiontopreventsuchprogression.Varioussurgicalproceduresare availabledependingonthelocationofthelesion.Theseinclude pancreaticoduodenectomy (Whippleprocedure), distal pancrea-tectomy, and central pancreatectomy. Central pancreatectomy, rather thanpancreaticoduodenectomyordistalpancreatectomy, have become thesurgical choice of interest for benign lesions of the pancreas limited to the pancreatic body [4,6,7]. This is becausesuchsurgicalprocedureallows fororgantissue preser-vation andreductionofcomplications suchasdiabetesmellitus andexocrinepancreasglandinsufﬁciency,whilestillmaintaining highoncologicefﬁciency[1,3,6]. Inthis casereport,wepresent a patientwithabenigncentrally locatedpancreaticcyst

under-∗ Correspondingauthorat:IstanbulUniversityCerrahpasa,CerrahpasaFacultyof Medicine,Cerrahpasa,KocaMustafapasaCd.No:53D:No:53,34096,Fatih,Istanbul, Turkey.

E-mailaddresses:[email protected](O.Orhan),[email protected]

(S.Carkman),[email protected](E.Erginoz),[email protected](M.F.Ozcelik).

goingcentralpancreatectomywithdistalpancreaticogastrostomy procedure.

2. Presentationofcase

A22-year-oldwomanpresentedtothegeneralsurgery depart-mentwithcomplaintsofvagueupperabdominalpainforseveral weeksinlength.Shedeniednausea,vomiting,fever,andweight loss.Noothersymptomswerepresent.Pastmedicalhistoryand surgicalhistory wasunremarkable.Uponadmissiontothe hos-pital,thephysicalexaminationofthepatientwasunremarkable. Hemogramandroutinebiochemistrylaboratoryresultswere nor-malexceptforanASTlevelof43.1IU/L(normalis<32IU/L)andan amylaselevelof155U/L(normalis28–100U/L).Serumelectrolyte levelswerenormal.HbA1clevelwas5%(normalis4.8–6.0%)and 31.15mmol(normalis29–42mmol).Urinalysisrevealed bacteri-uriaandhematuria.Viralserologywasnegativeandtumormarkers werewithinthenormal limits.AbdominalCT revealeda 2× 2 cmcysticlesiononthemid-pancreaticregion,adjacenttoceliac bifurcation,andthepancreaticductswerenotdilated.Biopsywith endoscopicultrasoundrevealedsolidpseudopapillary neoplasia. Duringtheoperation,the2×2cmlesionwasresectedwithcentral pancreatectomyanddistalpancreaticogastrostomywasperformed

https://doi.org/10.1016/j.ijscr.2020.09.189

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O.Orhanetal. InternationalJournalofSurgeryCaseReports76(2020)153–155

Fig.1.Centralpancreatectomywithdistalpancreaticogastrostomy.

(Fig.1).Thepathologyoftheresectedspecimenwasconsistentwith solidpseudopapillaryneoplasia.

Duringthepost-operativeperiod,thepatienthadfeverof sev-eral days in length. The laboratoryresults were unremarkable exceptforanincreaseind-dimerandﬁbrinogenlevels.Because of theon-going coronavirus disease(COVID-19) pandemic, the patientwasradiologicallyandimmunologicallytested.CTofthe thoraxshoweda 3.5cm pleuraleffusionin thelefthemithorax alongwithacompressiveatelectasis.COVID-19Polymerasechain reaction(PCR)testofthepatientresultedinapositivetestresult andthepatientwasadmittedtotheCOVID-19patientwardfour daysaftersurgery.

3. Discussion

The surgicalmanagement ofpancreaticcystsandneoplasms variesdependingonthelocationofthelesiononthepancreas.Due toitslocation,thereiscontroversyregardingthesurgicalapproach tonon-cancerouspancreatictumorslocatedinthepancreaticbody. Distal pancreatectomyoperationisoftenperformedfor pancre-atic body and tail tumors [8]. Althoughit is more challenging to perform, an organ-sparing central pancreatectomyapproach tonon-cancerouspancreatictumorsshouldbeconsideredinthe surgical management in order to reduce serious complications suchas diabetes mellitusand exocrine glandinsufﬁciency,and alsotopreservehealthorgantissue [1,5,6].Hence,central pan-createctomywithpancreaticogastrostomyisararetechniquefor mid-pancreaticcystsandisanalternativeto pancreticoduodenec-tomyordistalpancreatectomywithbetterfunctionaltissuereserve [2].

4. Conclusion

Distal pancreatectomyis thesurgicaloperationof choicefor cystslocatedonthebodyofpancreas.Althoughitcanbecurative, thisoptionresultsinthelossofhealthydistalpancreastissue. Cen-tralpancreatectomy,asseeninthiscasereport,isanalternative surgicaloperationofchoicewheretheremainingdistalpancreas is anastomosedtothestomach,resultinginthepreservation of healthypancreatictissuewhichminimizestheriskofdeveloping complications.

ThisstudyhasbeenreportedinlinewiththeSCARE2018criteria [9].Writteninformedconsentwasobtainedfromthepatientfor publicationofthiscasereportandaccompanyingimages.Acopy ofthewrittenconsentisavailableforreviewbytheEditor-in-Chief ofthisjournalonrequest.

DeclarationofCompetingInterest

Authorshavenoconﬂictsofinteresttodeclare.

Funding

Thisresearchdidnotincludeanyfunding.

Ethicalapproval

Thisresearchdidnotincludeanethicsapproval.

Consent

Writteninformedconsentwasobtainedfromthepatientfor publicationofthiscasereportandtheaccompanyingimages.

Authorcontribution

MehmetFaikOzcelik:Casereportconcept.

OrhanOrhan:Casereportconceptandinterpretation.

ErginErginoz:Casereportconceptandinterpretation,writing thepaper.

SinanCarkman:Casereportconcept.

Registrationofresearchstudies

N/A.

Guarantor

ErginErginoz. OrhanOrhan.

Provenanceandpeerreview

Notcommissioned,externallypeer-reviewed.

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