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A multicenter survey on distal pancreatectomy in Italy: results of minimally invasive technique and variability of perioperative pathways

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Abstract

No data are available about distal pancreatectomy (DP) in Italy, regarding variability of care among centers, and outcome of minimally invasive distal pancreatectomy (MIDP) in a multicenter setting. Hence, a survey was conducted among 20 institutions experienced in pancreatic surgery by the Italian Association for Study of Pancreas. Centers were asked to fill in two questionnaires about (1) general approach and perioperative protocols for DP and MIDP; (2) detailed operative results of MIDP in the period 2010–2011. Results of questionnaire 1: a great variability in perioperative approach was observed: octreotide was used in 50 % of centers, enzyme supplementation in 35 %, postoperative gastric suction in 80 % and oral liquids on day 1 in 55 %. All hospitals used at least one drain and its removal ranged between days 3–5 (in absence of fistula). Differences in type and timing of post-splenectomy vaccinations were recorded. As regards MIDP, 17/20 centers performed laparoscopic or robotic DP. MIDP rate on overall DP varied among centers (range 0–82 %) and it doubled from 2007 (14 %) to 2011 (28 %). Results of questionnaire 2: in the period 2010–2011, 171 MIDP were performed (140 laparoscopic, 31 robotic). Overall conversion rate was 17 %, mean operative time was 230 min and blood loss 285 ml. Mortality was nil and morbidity was 62 %, with 4 % relaparotomies. Pancreatic fistula occurred in 49 % (grade A 35 %, B 14 %). Mean postoperative stay was 9.8 days with 10 % readmission rate. The results indicated a great variability in DP management among Italian centers. Most centers performed MIDP, but MIDP rate on overall DP largely varied among centers. As regards MIDP conversion rate and hospital stay were found to be worse than those in single-institution series.

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Conflict of interest

The authors declare no conflict of interest.

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Author notes

  1. M. Falconi

    Present address: Clinica Chirurgia del Pancreas, Università Politecnica delle Marche, Ancona, Italy

Authors and Affiliations

  1. Pancreas Unit, Department of Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    G. Balzano & M. Bissolati

  2. UO di Chirurgia Generale e dei Trapianti, Università di Pisa, Pisa, Italy

    U. Boggi

  3. Unit of Surgery B, The Pancreas Institute, Department of Surgery and Oncology, G.B. Rossi Hospital, University of Verona, Verona, Italy

    C. Bassi

  4. Section of Pancreatic Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy

    A. Zerbi

  5. Dipartimento di Chirurgia, Ospedale Sacro Cuore Don Calabria, Negrar, Italy

    M. Falconi

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Consortia

AISP Study Group on Distal Pancreatectomy

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Correspondence to G. Balzano.

Additional information

Members of AISP Study Group on Distal Pancreatectomy are listed in “Appendix”.

Appendix: Members of AISP Study Group on Distal Pancreatectomy

Appendix: Members of AISP Study Group on Distal Pancreatectomy

E. Jovine: Department of Surgery, Maggiore Hospital, Bologna

F. Minni: Dipartimento di Scienze Mediche e Chirurgiche, Policlinico S.Orsola-Malpighi, Alma Mater Studiorum, Università di Bologna

G. Melotti: Department of General and Emergency Surgery, NOCSAE, Modena

R. Coppola: Chirurgia Generale, Università Campus Bio-Medico, Roma

A. Pietrabissa: Chirurgia Generale Seconda, Fondazione IRCCS Policlinico San Matteo

G. Francioni: Department of General Surgery, Infermi Hospital, Rimini

A. Ferrero: Department of General and Oncological Surgery, Ospedale Mauriziano “Umberto I”, Turin

D. Campra: Chir. Generale 4, AOU Città della Salute e della Scienza, Torino

G.B. Doglietto: Department of Digestive Surgery, Catholic University, A. Gemelli Hospital, Rome

M. Filauro: General and Biliopancreatic Surgery Unit, Ospedale Galliera, Genoa

P. Di Sebastiano: Department of surgery, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo; (present position: Surgical Oncology, ASL 2 Chieti)

P. Mezzatesta: Oncologia Chirurgica, Ospedale La Maddalena, Palermo

S. Intini: Clinica Chirurgica, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine

C. Pasquali: Department of Surgery, Oncology and Gastroenterology University of Padua

G.E. Gerunda: Department of Surgery and Transplantation, University of Modena and Reggio Emilia, Modena

R. Pezzilli: Dipartimento Malattie Apparato Digerente e Medicina Interna, Policlinico Sant’Orsola-Malpighi, Bologna

N. Pecorelli: Pancreas Unit, Department of Surgery, San Raffaele Scientific Institute, Milan, Italy

R. Ariotti: Pancreas Unit, Department of Surgery, San Raffaele Scientific Institute, Milan, Italy

N. De Lio: UO di Chirurgia Generale e dei Trapianti, Università di Pisa

L. Barbarello: UO di Chirurgia Generale e dei Trapianti, Università di Pisa

G. Butturini: Unit of Surgery B, The Pancreas Institute, Department of Surgery and Oncology, G.B. Rossi Hospital, University of Verona

R. Salvia: Unit of Surgery B, The Pancreas Institute, Department of Surgery and Oncology, G.B. Rossi Hospital, University of Verona

F. Gavazzi: Section of Pancreatic Surgery, Humanitas Research Hospital, Rozzano, Milan

M.R. Angiolini: Section of Pancreatic Surgery, Humanitas Research Hospital, Rozzano, Milan

S. Partelli: Dipartimento di Chirurgia, Ospedale Sacro Cuore Don Calabria, Negrar (present position; Clinica Chirurgia del Pancreas, Università Politecnica delle Marche, Ancona)

M. Masetti: Department of Surgery, Maggiore Hospital, Bologna

N. Zanini: Department of Surgery, Maggiore Hospital, Bologna

R. Casadei: Dipartimento di Scienze Mediche e Chirurgiche, Policlinico S.Orsola-Malpighi, Alma Mater Studiorum, Università di Bologna

C. Ricci: Dipartimento di Scienze Mediche e Chirurgiche, Policlinico S.Orsola-Malpighi, Alma Mater Studiorum, Università di Bologna

D. Marchi: Department of General and Emergency Surgery, NOCSAE, Modena

D. Borzomati: Chirurgia Generale, Università Campus Bio-Medico, Roma

A. Vinci: Chirurgia Generale Seconda, Fondazione IRCCS Policlinico San Matteo

L. Veneroni: Department of General Surgery, Infermi Hospital, Rimini

N. Russolillo: Department of General and Oncological Surgery, Ospedale Mauriziano “Umberto I”, Turin

S. Silvestri: Chir. Generale 4, AOU Città della Salute e della Scienza, Torino

S. Alfieri: Department of Digestive Surgery, Catholic University, A. Gemelli Hospital, Rome

G. Angelini: General and Biliopancreatic Surgery Unit, Ospedale Galliera, Genoa

F. Di Mola: Department of surgery, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo; (present position: Surgical Oncology, ASL 2 Chieti)

L. Mandalà: Oncologia Chirurgica, Ospedale La Maddalena, Palermo

A. Risaliti: Clinica Chirurgica, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine

A.C. Milanetto: Department of Surgery, Oncology & Gastroenterology University of Padua

R. Ballarin: Department of Surgery and Transplantation, University of Modena and Reggio Emilia, Modena.

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Balzano, G., Bissolati, M., Boggi, U. et al. A multicenter survey on distal pancreatectomy in Italy: results of minimally invasive technique and variability of perioperative pathways. Updates Surg 66, 253–263 (2014). https://doi.org/10.1007/s13304-014-0273-0

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