Acs, Miklos and Zustin, Jozef and Bogovic, Niklas and Piso, Pompiliu and Blaj, Sebastian (2025) Is the tail of the pancreas always tumor-infiltrated when macroscopically affected during cytoreductive surgery? A clinicopathological study and experience from a high-volume center. WORLD JOURNAL OF SURGICAL ONCOLOGY, 23 (1): 300. ISSN , 1477-7819
Full text not available from this repository. (Request a copy)Abstract
BackgroundDistal pancreatic resection during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is rare, with limited knowledge available. Therefore, a retrospective observational study was conducted using the data registry of a single institution to identify patients that underwent distal pancreatic resection during CRS + HIPEC.MethodsAll resected pancreatic specimens were examined for invasive parenchymal tumor infiltration. Pre-, peri-, and postoperative variables and their associations were analyzed.ResultsOver a period of more than a decade, 31 of 1275 patients (2.43%) underwent distal pancreatic resection as part of CRS. Infiltration of the pancreatic parenchyma was confirmed in almost one-third (29.03%) of the cases. Postoperative pancreatic fistulas occurred in 25.81% of patients (87.5% Grade B; 12.5% Grade C). The need for distal pancreatic resection was closely related to tumor burden in the left upper abdomen, with 87% of patients requiring peritonectomy of the left upper abdomen in addition to visceral resection. Pancreatic infiltration (n = 9/31) was diagnosed in 3 cases of gastric carcinoma, 2 cases of colorectal carcinoma, 2 cases of primary peritoneal carcinoma, 1 case of ovarian carcinoma, and 1 case of mucinous appendiceal carcinoma. Postoperative pancreatic fistulas were more frequently associated with primary tumors of the large intestine (87.50% vs. 30.43%; P = 0.0094), and a tendentiously longer total hospital stay was required for the "with pancreatic fistula" group (32.50 +/- 19.93 days vs. 21.78 +/- 10.14 days), with no impact on patient survival.ConclusionsAccepting a slightly increased morbidity, distal pancreatic resection is a reasonable approach to achieve complete macroscopic tumor resection. Nonetheless, our study shows that apparent tumor invasion is histologically rare in cases with favorable tumor biology, such as low-grade pseudomyxoma peritonei. Therefore, pancreatic resection should be avoided in cases of mucinous tumors to prevent fistula formation.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | INTERNATIONAL STUDY-GROUP; DISTAL PANCREATECTOMY; INTRAPERITONEAL CHEMOTHERAPY; RISK-FACTORS; PERITONEAL; MANAGEMENT; FISTULA; COMPLICATIONS; SPLENECTOMY; OVARIAN; Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Pancreatic tail resection; Peritoneal surface malignancy; Pancreatic fistula |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Chirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 26 Aug 2026 13:26 |
| Last Modified: | 26 Aug 2026 13:26 |
| URI: | https://pred.uni-regensburg.de/id/eprint/66135 |
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