| A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | |
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1 | 1. Goal | 2. Goal Topics | 3. Objective Topics | 4. SME Provided Objectives | Person Assigned | Suggested Instructional Methods | Suggested Assessment Methods | Additional committee comments | ||||||||||||||||||
2 | Competency Level: Equip the surgeon with the requisite knowledge of the anatomical and other patient considerations to perform MIS distal pancreatectomy with splenectomy | Pre-Operative: Equip the surgeon with the requisite knowledge of the anatomical and other preoperative patient considerations to perform MIS distal pancreatectomy with splenectomy. | Presentation: Typical and atypical presenting signs & symptoms of a patient with left sided pancreatic lesion DDx: Other clinical conditions to consider in the differential (ie: pancreatic pseudocyst, cystic neoplasm, neuroendocrine tumor, adenocarcinoma) Diagnostic work-up: Which tests? How are they performed? How to interpret them? Management considerations: Understand correct work-up of mass vs. cystic neoplasm. | Upon completion of this module, the learner will be able to: 1. Describe the typical presentation of patients with left sided pancreatic lesions. 2. Distinguish between a solid mass versus cystic neoplasm. 3. Explain the diagnostic work-up for cystic neoplasms based on guidelines for management. 4. Discuss the utility of and indications for CT, MRI, and endoscopic ultrasound with fine needle aspiration biopsy. 5. Interpret fluid analysis findings from cystic neoplasms of the pancreas. 6. Describe a strategy for patient selection that incorporates the patient’s comorbidities, diagnostic workup, and choice of procedure. 7. List the appropriate pre-operative vaccinations for a patient undergoing splenectomy. | Kevin El-Hayek | Video 1. https://www.sages.org/video/minimally-invasive-distal-pancreatectomy-to-preserve-or-not-preserve-the-spleen/ Articles 1. https://link.springer.com/article/10.1007/s11894-018-0638-5 2. https://www.uptodate.com/contents/surgical-resection-of-lesions-of-the-body-and-tail-of-the-pancreas?csi=b0348f83-e963-4cab-87e0-6bbf9b3d4bf5&source=contentShare 3. https://www.ncbi.nlm.nih.gov/pubmed/32151358 4. https://www.ncbi.nlm.nih.gov/pubmed/31567509 5. https://www.ncbi.nlm.nih.gov/pubmed/28735806 | 1. MCQ for appropriate work up for cystic neoplasms 2. MCQ for appropriate work up of low-grade pancreatic neoplasms 3. MCQ for appropriate splenic vaccinations needed 4. MCQ for appropriateness of performing concomitant splenectomy vs attempting splenic preservation vs proceeding with RAMPS (adenocarcinoma) | 1 - do a search for “lap” and convert to “mis”. Saw a couple but may have been more 2 - I only see conversion once in regard to post op outcomes. There is mention of vascular dissection. There is mention of management of bleeding. I think durin intra-op in one or all discussion of conversion should be overtly discussed. Perhaps in competence for unexpected bleeding and for mastery for need of vascular resection. Many ways to consider but given rates PV conversion especially for lap this requires discussion (Melissa Hogg) | ||||||||||||||||||
3 | Intra Op: Assist the surgeon in acquiring the required knowledge and operative skills to perform MIS distal pancreatectomy with splenectomy. | Describe patient position and trocar placement. Explain the critical steps of a distal pancreatectomy and splenectomy. Demonstrate the key anatomic landmarks for distal pancreatectomy and splenectomy. Assess which clinical scenarios require further intraoperative modalities such as intraoperative ultrasound. Describe bail-out techniques for bleeding/intraoperative complications and conversion to hand-assisted vs open surgery. | Upon completion of this module, the learner will be able to: 1. Describe patient positioning and trocar placement for distal pancreatectomy with splenectomy. 2. Explain at least 1 method for mobilizing and retracting the greater curvature of the stomach and exposing the pancreatic tail. 2. List at least 2 techniques for verifying adequate parenchymal margin prior to pancreas transection. 3. Explain at least 3 methods of parenchymal transection. 4. Describe at least 3 methods of major peripancreatic vessel transection. 5. List at least 3 factors that increase the risk of pancreatic fistula. 6. Discuss the advantages and disadvantages of drain placement. 7. Describe a strategy for managing intraoperative bleeding. 8. List at least 3 indications for conversion to an open/hybrid approach. | Edwin Okendi | Videos 1. https://www.sages.org/video/port-placement-for-distal-pancreatectomy/ 2. https://www.youtube.com/watch?v=k61uZ6hRCjc 3. https://www.sages.org/video/technique-of-minimal-invasive-distal-pancreatectomyin-the-u-s/ 4. https://www.sages.org/video/laparoscopic-distal-pancreatectomy-clockwise-asbuns-technique/ 5. https://www.sages.org/video/pancreatic-transection-techniques/ 6. https://www.sages.org/video/pancreatic-transection-techniques-2/ 7. https://www.sages.org/video/video-face-off-panel-distal-pancreatectomy-panel-discussion-2/ 8. https://www.youtube.com/watch?v=RLyW7o1TUHw Articles 1. https://link.springer.com/article/10.1007%2Fs00464-011-1618-0 2. http://downloads.hindawi.com/journals/grp/2015/472906.pdf | 1. MCQs for clinical knowledge and short-essay questions for description of key steps of distal pancreatectomy and splenectomy procedure as well as management of intra-operative and postoperative complications. 2. Oral boards-style assessment of for intra-operative scenarios 3. Online individual case video review, critique and rating by experts using C-SATS system, the Global Assessment of Laparoscopic Skills (GOALS) system, Global Evaluative Assessment of Robotic Skills (GEARS) etc. 4. Photo and video vignettes to assess intra-operative decision-making and judgment; for example, can have short 10-second video clips of different key portions of distal pancreatectomy and splenectomy and ask where one would start the dissection, where would they transection the pancreas, which plane to follow for dissection, extent of dissection, identity critical anatomy etc. 5. Intra-operative live case observation, proctoring and evaluation for intra-operative skill assessment and feedback as well as use of validated intra-operative assessment tools like OSATS and NOTSS 6. Technical skills assess can also be assessed by the SAGES FLS. | ||||||||||||||||||||
4 | Post Op: Manage post-operative issues following MIS distal pancreatectomy with splenectomy. | Pathway: Typical immediate post-op pathway (e.g., diet, activity, med changes, drain management, etc) Outcomes: Typical expected outcomes (e.g., % of patients with curative surgery vs those who require ongoing surveillance, e.g. IPMN vs adenocarcinoma) Short-term post-op complications: (e.g., PE, DVT, hemorrage, pancreatic fistula) – incidence, diagnostics, how to manage them Long-term post-op complications: (e.g., diabetes, post-splenectomy sepsis) – incidence, diagnostics, how to manage them | Upon completion of this module, the learner will be able to: 1. Describe the typical immediate post-operative pathway following a distal pancreatectomy and splenectomy (including diet, activity, medications, and drain management). 2. Discuss the post-operative surveillance algorithm for a patient with IPMN and for a patient with adenocarcinoma. 3. List at least 4 potential short-term post-operative complications and describe a diagnostic and management strategy for each. 4. List at least 2 potential long-term post-operative complications and desribe a diagnostic and management strategy for each. | Nicolo Pecorrelli | Articles Postoperative management (pathways) Enhanced recovery pathways in pancreatic surgery: State of the art. https://www.ncbi.nlm.nih.gov/pubmed/27605881 Enhanced Recovery pathways in Pancreatic Surgery. https://www.ncbi.nlm.nih.gov/pubmed/27865279 Drain management A Prospective Randomized Multicenter Trial of Distal Pancreatectomy With and Without Routine Intraperitoneal Drainage. https://www.ncbi.nlm.nih.gov/pubmed/28692468 Drain Management Following Distal Pancreatectomy: Characterization of Contemporary Practice and Impact of Early removal. https://www.ncbi.nlm.nih.gov/pubmed/30943185 Complications Postpancreatectomy Complications and Management. https://www.ncbi.nlm.nih.gov/pubmed/27865280 Postoperative Management in Patients Undergoing Major Pancreatic Resections. In: Tewari M. (eds) Surgery for Pancreatic and Periampullary Cancer. Springer, Singapore Long term outcomes Pancreatic exocrine insufficiency following pancreatic resection. www.ncbi.nlm.nih.gov/pubmed/26145836 New-onset diabetes after distal pancreatectomy: a systematic review. www.ncbi.nlm.nih.gov/pubmed/24983994 Complications in the adult asplenic patient: A review for the emergency clinician. https://www.ncbi.nlm.nih.gov/pubmed/32247651 | 1. MCQs for postoperative management. Describe postoperative ERAS pathway or typical postoperative management. 2. MCQs for drain management and POPF treatment. 3. Series of postoperative scenarios covering different complications, with MCQs regarding workup and management. 4. Case scenarios with scans of post-discharge complications (eg. fluid collections; splenic artery stump pseudoaneurysm). 5. MCQs for long-term sequelae of distal pancreatectomy and splenectomy (e.g. diabetes, exocrine insufficiency, asplenia). | ||||||||||||||||||||
5 | Proficiency Level: Equip the surgeon with the requisite knowledge of the anatomical and other patient considerations to perform MIS spleen preserving distal pancreatectomy (SPDP) | Pre Op: Equip the surgeon with the requisite knowledge of the anatomical and other preoperative patient considerations to perform MIS SPDP. | Describe the proper cilical and radiological evaluation for a patient presenting with a central or distal cystic or solid tumor of the pancreas that can be a candidate for spleen preserving distal pancreatectomy (SPDP). Evaluate the anatomical implications and planning of the operation based on integration of the clinical and radiological results. Describe the management options and steps of the operation based on individual cases. | Upon completion of this module, the learner will be able to: 1. List the benefits of MIS SPDP 2. Outline the recommended pre-operative workup for a patient prior to MIS SPDP 3. Describe a treatment strategy for a specific patient who is a candidate for MIS SPDP. 4. Explain the pre- and post-operative findings that constitute an oncologically safe and effective procedure. 5. List at least 3 contraindications for splenic preservation during MIS distal pancreatectomy. | Marc Mesleh | Videos 1. https://www.sages.org/video/minimally-invasive-distal-pancreatectomy-to-preserve-or-not-preserve-the-spleen/ - Lecure from SAGES 2018 on "To Preserve or Not Preserve the Spleen" 2. https://www.sages.org/video/technical-aspects-spleen-preserving-distal-pancreatectomy/ - Techincal Aspects of Spleen Preserving Distal Pancreatectomy 3. https://www.sages.org/video/technique-of-minimal-invasive-distal-pancreatectomy-in-korea/ - TECHNIQUE OF MINIMAL INVASIVE DISTAL PANCREATECTOMY IN KOREA - Technique of Splenic Preservation Articles 1. https://www.hpbonline.org/article/S1365-182X(16)31174-1/fulltext - Laparoscopic spleen-preserving distal pancreatectomy with and without splenic vessel preservation – a comparative study 2. https://www.hpbonline.org/article/S1365-182X(16)00366-X/fulltext - Spleen-preserving pancreatic resections with preservation of splenic vessels: A cautionary note on the risk of vascular complications 3. https://link.springer.com/article/10.1007/s00464-018-6277-y - Kim, H.S., Park, J.S. & Yoon, D.S. True learning curve of laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation. Surg Endosc 33, 88–93 (2019). 4. https://link.springer.com/article/10.1007/s00464-019-06901-z - Moekotte, A.L., Lof, S., White, S.A. et al. Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study. Surg Endosc 34, 1301–1309 (2020). | 1. MCQ regarding Benefits of Splenic Preservation 2. List several pancreatic lesions (Serous Cystadeoma, MCN, IPMN, PNET) and must describe scenarios in which Splenic preservation is or is not indicated 3. Show several CT/MRI of Pancreatic Lesions - must describe the findings and if Splenic Preservation is indicated and possible 4. Oral Boards Style - Discuss the oncologic concerns for splenic preservation | |||||||||||||||||||
6 | Intra-Op: Assist the surgeon in acquiring the required knowledge and operative skills to perform MIS SPDP. | Preparation: Appropriate identification and listing of pathways for operative clearance (E.g., bowel prep diet, antibiotics, clearance by anesthesia, preop labs, staging etc.) Positioning: How is the patient to be positioned and secured for the procedure? Instrument selection: Ports, staples, energy device, drains, sutures. Operative steps: Describe and execute the proper steps and its sequence along with trouble shooting common pitfalls. Describe differences between splenic vessel preserving SPDP versus Warshaw technique. List possible reasons for need to convert to open surgery Debrief: Analyze, describe and summarize events and results of the operation along with feedback discussion with a surgeon who is a master in MIS SPDP | Upon completion of this module, the learner will be able to: 1. Explain at least one intraoperative strategy for vascular control, pancreas dissection, node harvesting, and obtaining R0 margins. 2. Describe appropriate patient positioning and trocar placement. 3. List the key anatomic landmarks related to the pancreas and spleen, and explain at least 2 common anatomic variations. 4. Discuss at least 2 indications for conversion to a hand-assisted or open procedure. 5. Compare and contrast splenic vessel-preserving SPDP versus the Warshaw technique. 6. Discuss the advantages and disadvantages of drain placement. | Adnan Alseidi | "Videos • https://www.sages.org/video/minimally-invasive-distal-pancreatectomy-to-preserve-or-not-preserve-the-spleen/ • https://www.sages.org/video/sages-distal-pancreatectomy-video-faceoff/ • https://www.sages.org/video/laparoscopic-splenic-and-vessel-preserving-distal-pancreatectomy/ Articles • Fernández-Cruz L, Martínez I, Gilabert R, Cesar-Borges G, Astudillo E, Navarro S. Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg. 2004 May-Jun;8(4):493-501. PubMed PMID: 15120376 • Fernández-Cruz L. Distal pancreatic resection: technical differences between open and laparoscopic approaches. HPB (Oxford). 2006;8(1):49-56. doi: 10.1080/13651820500468059. PubMed PMID: 18333239; PubMed Central PMCID: PMC2131367. • Warshaw A. L. Conservation of the spleen with distal pancreatectomy. JAMA Surgery. 1988;123(5):550–553. doi: 10.1001/archsurg.1988.01400290032004 • Robotic distal pancreatectomy with or without preservation of spleen: a technical note Amilcare Parisi, Francesco Coratti, Roberto Cirocchi, Veronica Grassi, Jacopo Desiderio, Federico Farinacci, Francesco Ricci, Olga Adamenko, Anastasia Iliana Economou, Alban Cacurri, Stefano Trastulli, Claudio Renzi, Elisa Castellani, Giorgio Di Rocco, Adriano Redler, Alberto Santoro, Andrea Coratti World J Surg Oncol. 2014; 12: 295. Published online 2014 Sep 23. doi: 10.1186/1477-7819-12-295 PMCID: PMC4190462 Book: • SAGES HPB ATLAS has a chapter on this. But I can not access it on line. | |||||||||||||||||||||
7 | Post Op: Manage post-operative issues following MIS SPDP. | Typical immediate post-op pathway (e.g., diet, activity, med changes, drain management etc) Outcomes: Typical expected outcomes (e.g., % of patients with curative surgery vs those who require ongoing surveillance e.g. IPMN vs adenocarcinoma) Short-term post-op complications: (e.g., PE, DVT, hemorrhage, pancreatic fistula, wound infection) – incidence, diagnostics, how to manage them timely and appropriately Long-term post-op complications: (e.g., diabetes, collections, etc) – incidence, diagnostics, how to manage them | Upon completion of this module, the learner will be able to: 1. Describe the typical immediate post-operative pathway following a distal pancreatectomy and splenectomy (including diet, activity, medications, and drain management). 2. Discuss the post-operative surveillance algorithm for a patient with IPMN and for a patient with adenocarcinoma. 3. List at least 4 potential short-term post-operative complications and describe a diagnostic and management strategy for each. 4. List at least 2 potential long-term post-operative complications and desribe a diagnostic and management strategy for each. | Nicolo Pecorelli | Videos https://www.sages.org/video/minimally-invasive-distal-pancreatectomy-to-preserve-or-not-preserve-the-spleen/ Articles Complications Splenic preservation versus splenectomy in laparoscopic distal pancreatectomy: a propensity score-matched study. https://www.ncbi.nlm.nih.gov/pubmed/31236723 Long term outcomes Long term outcome after minimally invasive and open Warshaw and Kimura techniques for spleen-preserving distal pancreatectomy: International multicenter retrospective study. www.ncbi.nlm.nih.gov/pubmed/31005470 Oncologic follow-up for pancreatic NETs ENETS Consensus Recommendations for the Standards of Care in Neuroendocrine Neoplasms: Follow-Up and Documentation. https://www.ncbi.nlm.nih.gov/pubmed/28222443 The North American Neuroendocrine Tumor Society Consensus Paper on the Surgical Management of Pancreatic Neuroendocrine Tumors. https://www.ncbi.nlm.nih.gov/pubmed/31856076 Oncologic follow-up for resected benign IPMNs Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. https://www.ncbi.nlm.nih.gov/pubmed/28735806 | 1. Series of postoperative scenarios covering different complications, with MCQs regarding workup and management. 2. Case scenarios with scans of post-discharge complications (e.g. fluid collections; splenic vein thrombosis and gastric varices). 3. MCQs for long-term sequelae of spleen preserving distal pancreatectomy (e.g. diabetes, exocrine insufficiency). 4. MCQs for follow-up of resected pancreatic neuroendocrine tumors. 5. MCQs for follow-up of resected bening branch duct IPMN. | ||||||||||||||||||||
8 | Mastery Level: Equip the surgeon with the requisite knowledge of the anatomical and other patient considerations to perform MIS radical antegrade modular pancreatosplenectomy (RAMPS) | Pre-Operative: Equip the surgeon with the requisite knowledge of the anatomical and other preoperative patient considerations to perform MIS RAMPS. | Presentation: Discuss the typical and atypical presenting signs & symptoms of a patient with left sided pancreatic adenocarcinoma. Indications: Discuss the oncologic foundations for RAMPS. Discuss which pancreatic neoplasms require RAMPS. Diagnostic work-up: Discuss the Endoscopic Studies needed to establish the diagnosis. What anatomic features (vascular, local invasion into adjacent organs) must be assessed on Cross-Sectional Imaging? Management considerations: Discuss the tumor characteristics in the Cross-Sectional Imaging that will be important in operative planning for RAMPS. Neoadjuvant Chemotherapy: Discuss the role of Neoadjuvant Chemotherapy for Pancreatic Adenocarcinoma. | Upon completion of this module, the learner will be able to: 1. Describe the typical presentation of a patient with left sided pancreatic adenocarcinoma. 2. Explain the oncologic rationale for RAMPS. 3. Discuss the utility of and indications for CT, MRI, and endoscopic ultrasound with fine needle aspiration biopsy. 4. Interpret CT and MRI images for vascular (portal vein, SMV, SMA, celiac axis) and adjacent organ involvement (left adrenal, stomach, transverse colon). 5. Describe a strategy for selecting patients for RAMPS that incorporates the patient’s comorbidities and diagnostic workup. 6. Discuss the role of neoadjuvant chemotherapy for left-sided pancreatic adenocarcinoma. | David Caba | https://www.sages.org/video/minimally-invasive-distal-pancreatectomy-to-preserve-or-not-preserve-the-spleen/ | ||||||||||||||||||||
9 | Intra-Operative: Assist the surgeon in acquiring the required knowledge and operative skills to perform MIS RAMPS. | Preparation: Any patient prep needed? (E.g., bowel prep, vaccinations) Positioning: What are the choices for patient positioning? Explain the critical steps of MIS RAMPS -Exposure: Techniques for exposing pancreatic body/tail -Parenchymal transection: Discuss options for division of pancreas -Vascular Dissection: Discuss dissection along SMV/PV, SMA and Celiac Axis -Body/Tail Mobilization: Describe the plane followed for RAMPS, and the margins of resection tangentially Discuss the different techniques of Anterior RAMPS and Posterior RAMPS Discuss the indication for Multivisceral Resection (Adrenal, Stomach, Colon) and vascular resection (SMV-PV or celiac axis resection) Discuss the indications for post-operative drain placement Intraoperative complications: most common and how to manage | Upon completion of this module, the learner will be able to: 1. Describe patient positioning and trocar placement for MIS RAMPS. 2. Explain the steps for complete RAMPS including lymph node harvest and tangential resection margin. 3. Compare and contrast Anterior versus Posterior RAMPS. 4. Discuss the advantages and disadvantages of drain placement. 5. Describe a method for multivisceral resection for local invasion of: i. adrenal ii. stomach iii. colon 6. Describe at least one strategy for the management of intra-operative bleeding. | Melissa Hogg | Video: • https://www.sages.org/video/standard-resection-vs-ramps/ • https://www.sages.org/video/standard-resection-vs-ramps-2/ • https://www.sages.org/video/technique-of-minimal-invasive-distal-pancreatectomy-in-korea/ • https://www.sages.org/video/video-face-off-panel-distal-pancreatectomy-conclusions/ • https://www.jove.com/video/60370/-?language=Arabic Articles: J Am Coll Surg. 2007 Feb;204(2):244-9. Epub 2007 Jan 4. Surg Endosc. 2011 Jul;25(7):2360-1. doi: 10.1007/s00464-010-1556-2. Epub 2011 Feb 7. Surg Endosc. 2014 Oct;28(10):2848-55. doi: 10.1007/s00464-014-3537-3. Epub 2014 May 23. Surg Endosc. 2017 Nov;31(11):4836-4837. doi: 10.1007/s00464-017-5561-6. Epub 2017 Apr 13. BMC Surg. 2017 Jan 7;17(1):2. doi: 10.1186/s12893-016-0200-z. Trials. 2020 Apr 3;21(1):306. doi: 10.1186/s13063-020-04250-0. Ann Surg Oncol. 2019 Mar;26(3):772-781. doi: 10.1245/s10434-018-07101-0. Epub 2019 Jan 4. HPB (Oxford). 2016 Oct;18(10):835-842. doi: 10.1016/j.hpb.2016.05.003. Epub 2016 Jul 8. Ann Surg. 2017 Sep;266(3):421-431. doi: 10.1097/SLA.0000000000002375. HPB (Oxford). 2015 Jan;17(1):11-6. doi: 10.1111/hpb.12265. Epub 2014 Apr 18. HPB (Oxford). 2018 Dec;20(12):1172-1180. doi: 10.1016/j.hpb.2018.05.014. Epub 2018 Jun 30. Surg Endosc. 2019 Oct 9. doi: 10.1007/s00464-019-07163-5. [Epub ahead of print] Surgery. 2020 Apr 2. pii: S0039-6060(20)30103-3. doi: 10.1016/j.surg.2020.02.018. [Epub ahead of print] Ann Surg. 2019 Jan;269(1):143-149. doi: 10.1097/SLA.0000000000002491. | 1. MCQ on components of ERAS protocols 2. MCQ on anatomic landmarks of anterior RAMPS 3. MCQ on anatomic landmarks of posterior RAMPS 4. Oral boards-style assessment of for advanced distal pancreatic cancer intra-operative scenarios 5. Cadaveric (if focused on anatomy) or porcine (if focused on elements of hemostasis) simulation labs to assess for technical readiness 6. RAMPS case observation with intra-op quizzing and scenario adjustment with skilled MIS pancreas surgeon 7. Intra-operative live case observation, proctoring and evaluation for intra-operative skill assessment and feedback as well as use of validated intra-operative assessment tools like OSATS and NOTSS 8. MCQ on POPF, drains, and mitigation strategies 9. Case scenarios with scans or video on Multivisceral or vascular resection and suitability for resection in general or MIS specifically. 10. Oral boards-style Case scenarios with locations of intra-op bleeding and methods to control bleeding and decisions on when to convert. | ||||||||||||||||||||
10 | Post-Operative: Manage post-operative issues following MIS RAMPS. | Pathway: Typical immediate post-op pathway (e.g., diet, activity, med changes, drain management, etc) Outcomes: Typical expected oncologic outcomes (indications for adjuvant chemotherapy and/or radiation). Short-term post-op complications: (e.g., PE, DVT, hemorrhage, pancreatic fistula) – incidence, diagnostics, how to manage them Long-term post-op complications: (e.g., diabetes, post-splenectomy sepsis) – incidence, diagnostics, how to manage them | Upon completion of this module, the learner will be able to: 1. Describe the typical immediate post-operative pathway following a distal pancreatectomy and splenectomy (including diet, activity, medications, and drain management). 2. Explain the indications for adjuvant chemotherapy and radiation. 3. List at least 4 potential short-term post-operative complications and describe a diagnostic and management strategy for each. 4. List at least 2 potential long-term post-operative complications and desribe a diagnostic and management strategy for each. | Nicolo Pecorrelli | Articles Postoperative management (pathways) Enhanced recovery pathways in pancreatic surgery: State of the art. https://www.ncbi.nlm.nih.gov/pubmed/27605881 Enhanced Recovery pathways in Pancreatic Surgery. https://www.ncbi.nlm.nih.gov/pubmed/27865279 Drain management A Prospective Randomized Multicenter Trial of Distal Pancreatectomy With and Without Routine Intraperitoneal Drainage. https://www.ncbi.nlm.nih.gov/pubmed/28692468 Drain Management Following Distal Pancreatectomy: Characterization of Contemporary Practice and Impact of Early removal. https://www.ncbi.nlm.nih.gov/pubmed/30943185 Complications Postpancreatectomy Complications and Management. https://www.ncbi.nlm.nih.gov/pubmed/27865280 Postoperative Management in Patients Undergoing Major Pancreatic Resections. In: Tewari M. (eds) Surgery for Pancreatic and Periampullary Cancer. Springer, SingaporeLong term outcomes Long term outcomes Pancreatic exocrine insufficiency following pancreatic resection. www.ncbi.nlm.nih.gov/pubmed/26145836 New-onset diabetes after distal pancreatectomy: a systematic review. www.ncbi.nlm.nih.gov/pubmed/24983994 Complications in the adult asplenic patient: A review for the emergency clinician. https://www.ncbi.nlm.nih.gov/pubmed/32247651 Oncologic follow-up and adjuvant treatment for pancreatic adenocarcinoma NCCN guidelines for pancreatic adenocarcinoma https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf | 1. MCQs for postoperative management. Describe postoperative ERAS pathway or typical postoperative management. 2. MCQs for drain management and POPF treatment. 3. Series of postoperative scenarios covering different complications, with MCQs regarding workup and management. 4. Case scenarios with scans of post-discharge complications (eg. fluid collections; PPH). 5. MCQs for long-term sequelae of distal pancreatectomy and splenectomy (e.g. diabetes, exocrine insufficiency, asplenia). 6. MCQs for indications to adjuvant chemotherapy or radiation and follow-up for resected pancreatic adenocarcinoma | ||||||||||||||||||||
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12 | https://www.sages.org/video/laparoscopic-splenic-and-vessel-preserving-distal-pancreatectomy/ | |||||||||||||||||||||||||
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16 | Fernández-Cruz L, Martínez I, Gilabert R, Cesar-Borges G, Astudillo E, Navarro S. Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg. 2004 May-Jun;8(4):493-501. PubMed PMID: 15120376 | |||||||||||||||||||||||||
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18 | Fernández-Cruz L. Distal pancreatic resection: technical differences between open and laparoscopic approaches. HPB (Oxford). 2006;8(1):49-56. doi: 10.1080/13651820500468059. PubMed PMID: 18333239; PubMed Central PMCID: PMC2131367. | |||||||||||||||||||||||||
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20 | Warshaw A. L. Conservation of the spleen with distal pancreatectomy. JAMA Surgery. 1988;123(5):550–553. doi: 10.1001/archsurg.1988.01400290032004 | |||||||||||||||||||||||||
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22 | Robotic distal pancreatectomy with or without preservation of spleen: a technical note Amilcare Parisi, Francesco Coratti, Roberto Cirocchi, Veronica Grassi, Jacopo Desiderio, Federico Farinacci, Francesco Ricci, Olga Adamenko, Anastasia Iliana Economou, Alban Cacurri, Stefano Trastulli, Claudio Renzi, Elisa Castellani, Giorgio Di Rocco, Adriano Redler, Alberto Santoro, Andrea Coratti World J Surg Oncol. 2014; 12: 295. Published online 2014 Sep 23. doi: 10.1186/1477-7819-12-295 PMCID: PMC4190462 | |||||||||||||||||||||||||
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