Pancreas is a gland of the digestive system formed by an endocrine and an exocrine part and producing a number of important hormones, the most important of which are insulin, glucagon, somatostatin, etc. Its role in the digestive system is the secretion of the pancreatic juice that contains enzymes involved in the absorption of nutrients by the small intestine and the breaking down of carbohydrates, proteins and lipids.
Pancreatic inflammation is called pancreatitis and it’s mainly treated conservatively. Medical imaging plays a significant role in pancreatic conditions diagnosis, especially thin slices-CT scans.
Pancreatic neoplasms (tumours) are classified to those located on the endocrine and those located at the exocrine parts. Their biological behavior varies, distinguishing them into benign and malignant ones. Pancreatic adenocarcinoma is the most frequent representative of these diseases, arising from exocrine cells, while its prognosis is poor.
Pancreatic endocrine tumors (neuroendocrine) are of varying malignant potential. Depending on the secretion or not of various hormones, they are distinguished into non-functioning tumors causing pressure or infiltration symptoms on the adjacent tissues. These include pain, nausea, malaise, obstructive jauntice and into functioning tumors that secrete various hormones (e.g. gastrin, insulin, somatostatin, Vasoactive Intestinal Peptide etc.) causing the respective clinical features.
Another category of pancreatic neoplasms are primary cystic neoplasms. Serous cystic neoplasms that are nearly always benign and mucus cystic neoplasms cystic neoplasms are the typical representatives of this category as well as the intraductal papillary mucinous neoplasms that have a malignant potential.
Malignant neoplasms, among which pancreatic carcinoma is the most frequent, are diagnosed usually at an advanced stage when causing symptoms. They mostly require surgical management. Laparoscopic surgery plays a major part in diagnosis by performing biopsies and by managing via the enucleation of benign lesions, the performance of palliative procedures to bypass the GI tract and the biliary system in case of malignancy as well as by radical pancreatic resections at specialised centres.
The highly complicated laparoscopic total pancreatoduodenectomy with concurrent lymph node cleansing was successfully completed by Dr. Vasileios Drakopoulos, at a very rare case of a patient with coexisting Intraductal Papillary Mucinous Neoplasm (IPMN) and Solid Pseudopapillary Neoplasm of the Pancreas (SPNP). It is worth mentioning that it is the fourth recorded case of a patient with coexisting IPMN and SPNP and the first time they are treated laparoscopically.
Dr. Nikolaos Roukounakis valuably and continuously supported the procedure, along with the contribution of Dr. Dimitrios Manganas, both Directors of the 1st Surgery Clinic & Organ Transplant Unit. Dr, Vassilis Vougas, Head of the Clinic supervised the process, while surgeons Eleni Daskalaki and Sotirios Voulgaris both assisted Dr. Drakopoulos. The Nursing Staff of the Hospital and members of the Anesthesiology Department – Varvara Sfyra, Spyridoula Anthi, Vasiliki Bisbikou, Panagiotis Ouranis – substantially supported the long procedure, while Anesthesiologist Stella Giannaraki continued to support the patient postoperatively.
The patient, cared after by the medical and nursing staff of the 1st Surgery Clinic and following numerous post-operative exams by the Director of Radiology, Dr. Eleni Antypa, left the Hospital in excellent condition.