Significance Of Laparoscopic Total Pancreatectomy For Pancreatic Neoplasms:Case Report And Literature Review

Objective Laparoscopic total pancreatectomy is a complex surgical procedure that has rarely been reported.The purpose of this study was to investigate the safety and feasibility of laparoscopic total pancreatectomy,summarize and analyze the experience of laparoscopic total pancreatectomy in the treatment of pancreatic cancer,and describe a standardized surgical technique.Methods From January 2016 to June 2018,the clinical data of 2 cases of laparoscopic total pancreatectomy in Zhejiang People's Hospital were retrospectively analyzed,including perioperative details and short-term results,and the literature was reviewed.Results Two patients underwent total pancreatectomy with laparoscopic preservation of the spleen.The operation time was 270,360 min,the intraoperative blood loss was about 400,200 ml,and there were no deaths.No red blood cells and plasma were infused during the operation,and no need to transfer to ICU monitoring.Two patients recovered well under conservative treatment,and the postoperative hospital stay was 21 and 20 days.After the operation,insulin was administered by subcutaneous injection of insulin to supplement the trypsin.The postoperative pathology was: moderately differentiated ductal adenocarcinoma and pancreatic intraductal papillary mucinous neoplasm.Short-term follow-up(from 120 days to 600 days)showed that the levels of glycated hemoglobin were normal and the quality of life was comparable in 2 patients.Conclusion In selected patients,laparoscopic total pancreatectomy is feasible and safe,and has the advantage of minimally invasive surgery.The choice of surgical procedure should consider whether to retain the spleen if appropriate.In addition,further prospective randomized studies are needed to fully understand the role of laparoscopic techniques in total pancreatectomy,to maximize the postoperative clinical outcome of patients,and to obtain an objective assessment of the efficacy of laparoscopic total pancreatectomy.Pancreatic resection plays an increasingly important role in the treatment of pancreatic tumors.