Performance of Laparoscopic Pancreatoduodenectomy for Solid Pseudopapillary Tumor of Pancreas.

BACKGROUND Solid pseudopapillary tumor of the pancreas (Frantz tumor) is a rare, low-grade malignant neoplasm. Laparoscopic pancreatoduodenectomy is a good approach for tumors located in the pancreatic head. We present two successful cases in young women. CASE REPORT A 19-year-old woman was admitted to Department of Digestive Surgery due to epigastric pain, nausea, and vomiting. Computed tomography scan of the abdomen was performed, and a 3.0×2.2 cm solid tumor localized in the head of the pancreas was observed. After the diagnosis of Frantz tumor of the pancreas, the patient underwent laparoscopic pancreatoduodenectomy. Histopathology confirmed solid and cystic pseudopapillary tumor. The postoperative course was uneventful, and after 8 months the patient remained disease-free. An 18-year-old woman was admitted at the emergency room with abdominal pain, vomiting, and diarrhea. Computed tomography scans revealed a mass of 4.1×3.3 cm in size in the head of the pancreas consistent with a solid pseudopapillary tumor. Laparoscopic pancreatoduodenectomy was performed by two expert surgeons who divided the work: one did resection and the other did reconstruction. The patient was discharged at postoperative day 6 without complications, and during five months of follow-up the patient has been well and without disease. CONCLUSIONS Laparoscopic pancreatoduodenectomy can be performed safely in patients with Frantz tumor by surgeons with expertise in laparoscopic surgery, technical skill, and adequate equipment.

Ligadura da veia porta associada à transecção para hepatectomia em dois estágios (ALPPS): uma nova abordagem nas ressecções hepáticas / Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): a new approach in liver resections

RACIONAL: Insuficiência hepática pós-operatória devido a remanescente hepático pequeno tem sido complicação temida em pacientes que são submetidos à ressecção hepática extensa. A associação da transecção hepática e ligadura da veia porta para hepatectomia estagiada (ALPPS) é uma nova abordagem para pacientes em que o tumor é previamente considerado irressecável. OBJETIVO: Apresentar a técnica ALPPS como procedimento novo de hepatectomia em dois estágios com ligadura da veia porta e transecção hepática mantendo o fígado in situ para o tratamento de pacientes com tumores primários ou metastáticos marginalmente ressecáveis. TÉCNICA: O procedimento é realizado em dois tempos. O primeiro consiste na ligadura do ramo direito da veia porta. Em seguida é realizada a transecção total ou quase total do parênquima hepático acompanhando o ligamento falciforme, incluindo a veia hepática média. Um saco plástico é utilizado para recobrir o fígado que será retirado; o abdome é drenado e realizada a síntese da parede por planos. O segundo tempo é feito após seis a 12 dias de intervalo com realização de tomografia computadorizada de abdome. Na laparotomia o saco plástico é removido. Os ramos direito da artéria hepática, ducto hepático e veia hepática são ligados e o lobo hepático direito é removido. Um dreno é posicionado na superfície de ressecção e a síntese da parede abdominal é realizada. CONCLUSÃO: ALPPS permite ressecção curativa de lesões hepáticas em pacientes com doença considerada previamente irressecável.

BACKGROUND: Postoperative liver failure consequent to insufficiency of remnant liver is a feared complication in patients who underwent extensive liver resections. The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a new approach for patient which tumor is previously considered unresectable. AIM: To present ALPPS as an innovative surgical technique of two-staged hepatectomy for the treatment of patients with marginally resectable or initially nonresectable primary and metastatic liver tumors. TECHNIQUE: The procedure is performed in two steps. The first consists on ligation of the right portal vein branch. Subsequently, total or nearly total parenchyma dissection along the falciform ligament is performed, including the middle hepatic vein. A plastic bag is used to cover the right extended lobe, and the abdomen is drained and closed. The second one is performed after a computer tomography, six to 12 days interval. After laparotomy, the plastic bag is removed. The right artery, right bile duct and the right hepatic vein are divided. The extended right lobe is removed. Drain is placed at the resection surface, and the abdomen is closed. CONCLUSION: The associating of liver partition and portal vein ligation can enable curative resection of liver metastasis in patients with lesions previously considered unresectable.

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): a new approach in liver resections.

BACKGROUND: Postoperative liver failure consequent to insufficiency of remnant liver is a feared complication in patients who underwent extensive liver resections. The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a new approach for patient which tumor is previously considered unresectable. AIM: To present ALPPS as an innovative surgical technique of two-staged hepatectomy for the treatment of patients with marginally resectable or initially nonresectable primary and metastatic liver tumors. TECHNIQUE: The procedure is performed in two steps. The first consists on ligation of the right portal vein branch. Subsequently, total or nearly total parenchyma dissection along the falciform ligament is performed, including the middle hepatic vein. A plastic bag is used to cover the right extended lobe, and the abdomen is drained and closed. The second one is performed after a computer tomography, six to 12 days interval. After laparotomy, the plastic bag is removed. The right artery, right bile duct and the right hepatic vein are divided. The extended right lobe is removed. Drain is placed at the resection surface, and the abdomen is closed. CONCLUSION: The associating of liver partition and portal vein ligation can enable curative resection of liver metastasis in patients with lesions previously considered unresectable.