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A 30-Years Celebration of First Description of Central Pancreatectomy (the Dagradi-Serio-Iacono Operation): Historical Outline and Surgical Outcome
Calogero Iacono*1, Andrea Ruzzenente1, Simone Conci1, Claudio Bacchelli1, Tommaso Campagnaro1, Alessandro Valdegamberi1, Corrado Pedrazzani1, Francesca Bertuzzo1, Giuseppe Verlato2, Alfredo Guglielmi1
1Department of Surgey, Policlinico GB Rossi, Verona, Italy; 2Department of Public Health and Community Medicine, Policlinico GB Rossi, Verona, Italy
Background and aims:
Central Pancreatectomy (CP) is a parenchyma-sparing surgical procedure. The aims of this report are to celebrate a 30-year of CP, clarify the history and the development of CP and to evaluate the short- and long-term surgical results of CP from all published studies
Methods:
A worldwide historical research was performed. Furthermore, all studies published between 1988 and 2010 were systematically reviewed. Comparisons between CP and DP were pooled and analysed by standard meta-analytical techniques using the random or fixed effects model as appropriate.
Results:
Since 1907 several surgeons applied in the evolution of this technique, the pioneers in the demolitive part (Ehrhardt, Finney, Honjyo) and in the 50s in the reconstructive part (Guillemin and Bessott and Letton and Wilson), only Dagradi and Serio in 1984 published the complete surgical intervention including the resective and reconstructive aspects. Subsequently, Iacono has validated it with functional endocrine and exocrine tests and popularised it worldwide. In 2003, Baca and Bokan performed laparoscopic CP and, in 2004, Giulianotti et al. performed a robotic assisted CP.
Ninety-four studies, which involved 963 cases of CP, were identified. The postoperative morbidity rate was 45.3%; pancreatic fistula (PF) occurred in 40.9% of cases. Endocrine and exocrine pancreatic insufficiency were reported in 5.0% and 9.8% of patients, respectively. The overall mortality rate was 0.8%. Compared with DP, CP had a higher postoperative morbidity and a higher incidence of PF. The relative risk (RR) of postoperative endocrine insufficiency was 0.22 (95% confidence interval 0.14-0.35), which revealed a statistically significant benefit of CP (P < 0.001). The RR of exocrine failure was 0.59 (0.32-1.07). However, this result was not significant (P = 0.082) because of the large degree of heterogeneity among studies.
Conclusions:
30-years after the first description CP is performed worldwide either by open surgery or by using minimally-invasive or robotic approaches. CP seems to be a safe surgical procedure with good long-term functional reserve, although CP is associated with a slightly higher risk of PF than DP. The CP should be considered, with specific indications, not as an alternative to DP, but rather as a standard surgical procedure.
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