The SAGES Manual of Evolving Techniques in Pancreatic Surgery

Management of diseases of the pancreas is varied and complex, and the diagnoses leading to surgical consideration dictate what technical approaches are feasible and safe.  Over the last decade, this has changed considerably, and as a result, the necessity of documenting the updated surgical approaches is not only warranted yet paramount to surgeons.

This manual presents a contemporary description of pancreatic surgery.  The classic open approach maintains relevancy, yet refinement in technique has improved outcomes.  The application of laparoscopic techniques provides improvement in recovery when applied appropriately, yet further technological innovations continue to improve this approach.  Further innovation and research in robotic, percutaneous and endoscopic techniques have broadened the horizon of the management of pancreatic disease. Chapters in this manual address surgical therapy of benign and malignant disease of the pancreas, including management of acute and chronic pancreatitis as well as benign, premalignant and malignant pancreatic neoplasms, and will focus on specific disease processes and the various approaches that are currently applied. Each of the chapters addresses patient selection, pre-operative considerations, technical conduct of the procedures and minimizing morbidity.  A brief review of the existing literature addressing the particular topic is included in each chapter, with extensive illustrations and selected video clips.

Part I. Anatomy and Physiology.- Anatomy and Physiology.- Part II. Acute Pancreatitis.- Assessment of Severity and Medical Management.- Non-Surgical Therapies Including Gallstone Management.- Acute Pancreatitis: Surgical Therapies.- Acute Pancreatitis: Complications.- Part III. Chronic Pancreatitis.- Chronic Pancreatitis: Classification and Medical Management.- Chronic Pancreatitis: Drainage Procedures (Open vs. MIS).- Chronic Pancreatitis: Resection.- Chronic Pancreatitis: Combined Procedures (Open vs. MIS).- Chronic Pancreatitis: Total Pancreatectomy with Islet Cell Auto-Transplantation.- Part IV. Preoperative Diagnosis and Surgical Indications.- Benign, Premalignant, and Malignant Duodenal Neoplasms.- Endoscopic Duodenal Resection.- Surgical: Transduodenal Resection (Open vs. MIS).- Segmental Duodenal Resection (Open vs. MIS).- Cystic Neoplasms.- Pancreatic Ductal Adenocarcinoma.- Pancreatic Neuroendocrine Neoplasms.- Part V. PRRT.- Secondary malignant neoplasm (Melanoma, RCC, CRC, Sarcoma).- Part VI. Surgical Technique: Pancreatoduodenectomy.- Open Pancreatoduodenectomy.- Laparoscopic Distal Pancreatoduodenectomy.- Robotic Pancreatoduodenectomy.- Part VII. Surgical Technique: Distal Pancreatectomy.- Open Distal Pancreatectomy.- Laparoscopic Distal Pancreatectomy.- Robotic-Assisted Approach to Minimally Invasive Distal Pancreatectomy.- Splenic Preservation Distal Pancreatectomy.- Celiac Axis Resection (Modified Appelby).- Enucleation.- Minimally Invasive Central Pancreatectomy.- Palliative Surgery.- Part VIII. Perioperative Considerations and Management.- Preoperative Risk Stratification to Prehabilitation.- Enhanced Recovery Pathways: What’s the Evidence?- Perioperative Nutrition in Pancreatic Surgery.- Part IX. Postoperative Complications.- Short-term Morbidity after Pancreatectomy.- Prevention, Prediction, and Mitigation of Pancreatic Fistula.- Post-pancreatectomy Hemorrhage.- Delayed Gastric Emptying.- Long-term Sequelae: Pancreatic Exocrine and Endocrine Failure.- How to Measure Postoperative Outcomes.- SAGES University Masters Programs: Pancreatic Surgery Pathway.

Eugene P. Ceppa, MD, FACS, Department of Surgery, Indiana University School of Medicine, Simon Cancer Center, Indianapolis, IN, USA

Kevin M. El-Hayek, MD, MBA, FACS, Department of Surgery, The MetroHealth System, Case Western University School of Medicine, Cleveland, OH, USA

Melissa E. Hogg, MD, MS, FACS, Department of Surgery, NorthShore University Health System, Kellogg Cancer Center, Evanston, IL, USA

Nicolò Pecorelli, MD, MSc, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy