Pancreatic Surgery

Ospedale San Raffaele

key figures 

CLINICAL SERVICES:

  • Tumours of the pancreas and periampullary region
    • Tumours of the Pancreas, Ampulla, Distal Bile Duct and Duodenum
    • Cystic Tumours of the Pancreas
    • Neuroendocrine Tumours
  • Chronic and Acute Pancreatitis
  • Pancreatic islets autotransplantation after pancreatic resection of benign tumours

PROCEDURES PERFORMED PER YEAR:

  • 300 pancreatic resections
  • 60 resections by minimally invasive surgery

 

treatmentS

Pancreatic Tumours

Pancreatic tumour is a generic term and some fundamental distinctions must be made. Some tumours are very aggressive, but other types of pancreatic tumours are less so, or are completely benign. In other cases, an atypical picture of chronic pancreatitis can be confused with a tumour. To simplify the classification of pancreatic tumours, they can be divided into three major categories: adenocarcinoma, endocrine tumours and cystic tumours. The mainstay for an adequate treatment is a correct diagnosis and a multidisciplinary approach.

The Pancreatic Surgery Unit can provide a comprehensive evaluation of all suspected tumours of the pancreas or periampullary region, with state-of-the-art diagnostic tools (EndoscopicUltraSonography with biopsy, CT-scan or MRI) to define the adequate therapeutic strategy with a multidisciplinary approach in a single day. The Gastrointestinal Endoscopy section of the Pancreatic Department has one of the highest volumes in Europe of EndoscopicUltraSonography for pancreatic diseases, with a high diagnostic accuracy of pancreatic biopsies due to the rapid-on-site evaluation (ROSE) procedure. In patients with locally advanced, non-metastatic pancreatic cancer, that cannot be candidate to surgery, a minimally invasive local treatment of pancreatic cancer through Endoscopic Ultrasonography can be provided (EUS-guided cryothermal ablation).

Main Pathologies Treated:

  • Malignancies of the pancreas and periampullary region
    • Tumours of the Ampulla
    • Tumours of the Distal Bile Duct
    • Tumours of the Duodenum

Top Surgical Procedures:

  • Pancreaticoduodenectomy (Whipple Procedure)
  • Total pancreatectomy
  • Distal pancreatectomy (open or minimally invasive)

Cystic Tumours of the Pancreas

Cystic tumours of the pancreas are rare tumours, sometimes large, with a liquid content. They are divided into two main categories: serous cystic tumours and mucinous tumours. Serous cystic tumours are almost always benign, while mucinous tumours may undergo malignant transformation. Fortunately, in most cases even the mucinous tumours are diagnosed when they are still benign, and then you can decide, depending on the case, to proceed with the intervention or to define a control program with periodic MRIs or Endoscopic UltraSonography.

The Unit provides minimally invasive surgery when indicated. It also offers auto transplantation islets of Langerhans when removal of normal pancreatic tissue, together with the cyst, is needed. During an islet auto transplant, the patient's own islet cells are isolated from the removed pancreas. They are then put back into the patient, where they start producing insulin.  Minimally invasive pancreatic surgery, especially distal pancreatectomy, is routinely performed. The diagnosis and treatment path are defined in a multidisciplinary approach and can be done in one single day through the appropriate imaging studies and/or Endoscopic Ultrasonography with fine needle aspiration of cystic fluid, for cytology and subsequent analysis.

Main Pathologies Treated:

  • Pancreatic cysts
    • Serous Cysts
    • Mucinous Cysts

Top Surgical Procedures:

  • Pancreaticoduodenectomy (Whipple Procedure)
  • Total Pancreatectomy
  • Distal Pancreatectomy (open or minimally invasive)
  • Islets Auto transplantation

Pancreatic Neuroendocrine Tumours (P-NET or NEN)

These are neoplasms originating from the aggregates of endocrine cells present at the pancreatic level (Langerhans islets). These tumours are rare, but their detection has increased significantly over the last few years, because of the widespread use of increasingly accurate radiological techniques (CT and magnetic resonance imaging). Endocrine pancreatic tumours are divided into two groups: functioning and non-functioning tumours. Non-functioning tumours, also called "non-secreting" tumours, are the most frequent (70% of cases) and can become very voluminous, causing symptoms related to the compression of adjacent organs and structures. Functioning tumours (30% of cases) are instead characterized by the excessive production of some hormones and are often detected while still small because they prematurely manifest in the appearance of disorders related to increased hormone secretion.

The Unit is specialized in these types of tumours, providing minimally invasive surgery when indicated. The Unit also offers auto transplantation islets of Langerhans when removal of normal pancreatic tissue, together with the neuroendocrine tumour, is needed.  One-day in the Unit’s multidisciplinary setting is enough to ascertain the diagnosis of suspected neuroendocrine tumours and to define the therapeutic strategy. Notably, Professor Massimo Falconi is the current Chairman of the European Neuroendocrine Tumour Society (ENETS).

Main Pathologies Treated:

  • Neuroendocrine Tumours (NET)
    • Functioning (secreting)
    • Non-Functioning (non-secreting)

Top Surgical Procedures:

  • Pancreaticoduodenectomy (Whipple Procedure)
  • Total Pancreatectomy
  • Distal Pancreatectomy (open or minimally invasive)
  • Islets auto transplantation

Chronic and Acute Pancreatitis

Chronic pancreatitis is a disease caused by a mild but long-lasting pancreatic inflammation. The consequence of this prolonged inflammation is the slow but progressive, replacing the normal pancreas with tough scar tissue, becoming no longer functioning. The most frequent cause is chronic alcohol intake, but the disease may also be due to genetic causes or chronic obstruction of pancreatic juices drainage. A rare form of chronic pancreatitis is the autoimmune type, in which the pancreatitis is caused by a reaction of the immune system against the pancreatic cells.

The Unit is highly specialized in the treatment of pancreatitis. The diagnosis and patient’s clinical pathway (endoscopic or surgical) can be done in one day, following the multidisciplinary approach. The Unit offers autotransplantation of Langerhans islets in non-diabetic patients requiring, partial or total, pancreatectomy because of chronic pancreatitis. Multidisciplinary treatment is suggested for severe acute pancreatitis with minimally invasive step-up approach (with endoscopic necrosectomy or minimally invasive surgical necrosectomy).

Main Pathologies Treated:

  •  Pancreatitis
    • Chronic
    • Acute

Top Procedures for chronic pancreatitis:

  • Pancreaticoduodenectomy (Whipple Procedure)
  • Total Pancreatectomy
  • Distal Pancreatectomy
  • Islets Auto transplantation

Top Procedures for acute pancreatitis:

  • minimally invasive necrosectomy (VARD)
  • minimally invasive cholecystectomy

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • Pancreatic islets auto transplantation
  • Endoscopic Ultrasonography
  • Pancreatic biopsies with (ROSE) procedure
  • Endoscopic ultrasound-guided treatments