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Unraveling Pancreatic Segmentation

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Abstract

Background

Limited pancreatic resections are increasingly performed, but the rate of postoperative fistula is higher than after classical resections. Pancreatic segmentation, anatomically and radiologically identifiable, may theoretically help the surgeon removing selected anatomical portions with their own segmental pancreatic duct and thus might decrease the postoperative fistula rate. We aimed at systematically and comprehensively reviewing the previously proposed pancreatic segmentations and discuss their relevance and limitations.

Methods

PubMed database was searched for articles investigating pancreatic segmentation, including human or animal anatomy, and cadaveric or surgical studies.

Results

Overall, 47/99 articles were selected and grouped into 4 main hypotheses of pancreatic segmentation methodology: anatomic, vascular, embryologic and lymphatic. The head, body and tail segments are gross description without distinct borders. The arterial territories defined vascular segments and isolate an isthmic paucivascular area. The embryological theory relied on the fusion plans of the embryological buds. The lymphatic drainage pathways defined the lymphatic segmentation. These theories had differences, but converged toward separating the head and body/tail parts, and the anterior from posterior and inferior parts of the pancreatic head. The rate of postoperative fistula was not decreased when surgical resection was performed following any of these segmentation theories; hence, none of them appeared relevant enough to guide pancreatic transections.

Conclusion

Current pancreatic segmentation theories do not enable defining anatomical–surgical pancreatic segments. Other approaches should be explored, in particular focusing on pancreatic ducts, through pancreatic ducts reconstructions and embryologic 3D modelization.

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Authors and Affiliations

  1. Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France

    Yohann Renard, Claude Avisse & Reza Kianmanesh

  2. Department of Gastroenterology and Pancreatology, Beaujon Hospital (APHP) and Paris 7 University, DHU Unity, Clichy, France

    Louis de Mestier & Philippe Lévy

  3. IADI, U947, Université de Lorraine, INSERM, Nancy, France

    Yohann Renard & Manuela Perez

  4. Department of Anatomy, Faculty of Medicine and University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France

    Yohann Renard & Claude Avisse

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  1. Yohann Renard
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  4. Claude Avisse
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Correspondence to Yohann Renard.

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Renard, Y., de Mestier, L., Perez, M. et al. Unraveling Pancreatic Segmentation. World J Surg 42, 1147–1153 (2018). https://doi.org/10.1007/s00268-017-4263-5

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