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2006 Abstracts: Has the Dagradi-Serio-Iacono operation or Central Pancreatectomy Been Correctly Applied in Surgical Practice?
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Has the Dagradi-Serio-Iacono operation or Central Pancreatectomy Been Correctly Applied in Surgical Practice?
Calogero Iacono, Luca Bortolasi, Enrico Facci, Marco Frisini, Andrea Ruzzenente, Alfredo Guglielmi; Surgery and Gastroenterology, University of Verona , Verona , Italy

Since the Eighties the panorama of pancreatic surgery has been enlarged with the acquisition of a new operation: central pancreatectomy (CP). This operation was first performed by Dagradi and Serio in 1982 to resect an insulinoma of the pancreatic neck and described by them in 1984. In the last two decades Iacono and Serio have spent their effort to spread CP with correct indications that must be benign or low grade malignant tumours located in the pancreatic neck. In 1997 at 38th SSAT Meeting we put forward a question: “Is there a place for Central Pancreatectomy in Pancreatic Surgery?” (J Gastrointest Surg 1998; 2: 509-517) Now, eight years later, we believe to have the answer supported by our experience and the literature. The aim of the present work is to review our and literature experience in order to verify indications and results of this operation. At the Department of Surgery of the University of Verona 20 patients underwent CP. In the English literature (1988 to October 2005), 353 patients (350 laparotomic and 3 laparoscopic) have been reported. We have taken in consideration number of cases, sex, age, pathological diagnosis, size of tumour, operative time, estimated blood loss, blood transfusion, type of treatment of proximal and distal stumps, local and systemic complications, re-operation rate, mortality rate, length of hospital stay, endocrine and exocrine insufficiency, recurrence rate. Tumour pathology is available in 333 out of 373: the main indication for CP is serous and mucinous cystadenoma (124 pts) followed by endocrine tumours (96 pts) and Intraductal Mucinous Producing Neoplasms (IMPN) in 44 cases. The most performed reconstruction has been pancreatico-jejunostomy followed by pancreatico-gastrostomy. Considering all the cases (373) morbidity and mortality rate is 35% and 0.2%, respectively, while re-operation rate is 6%. Recurrence rate is 2.3% due to incorrect indication (cancer and IMPN). Endocrine and exocrine insufficiency is 4% and 4.3%. CP is a conservative procedure that is indicated for benign lesion or low grade malignant tumours; in IMPN CP should be applied with caution due to recurrences. Data of literature confirm our hypothesis regarding low mortality and acceptable morbidity, with very low incidence of pancreatic insufficiency. On the other hand it must be noticed that a incorrect indication entails a risk of recurrence and late complications. Eventually the Dagradi-Serio-Iacono operation is correctly applied in almost all the cases reported. However seen the limited number of cases for a single Institution we suggest for the future to collect all the new cases in a database to value more precisely the data.


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