Pancreatic Surgery

A pancreatic disease (pancreatic cancer or pancreatitis) requires highly experienced doctors. It is difficult to properly diagnose and treat a pancreatic disease by a doctor who only occasionally cares a patient with this problem, because pancreatic diseases are rare, the diagnosis is difficult and the surgical treatment is extremely complex.

Pancreatic cancer (adenocarcinoma) can be a very aggressive disease; conversely, other forms of pancreatic tumors have far better prognosis and sometimes they can be benign. Moreover, some benign pancreatic disease (e.g. pancreatitis) may be confused with a pancreatic tumor, or vice versa. Therefore, it’s essential to distinguish a pancreatic disease requiring surgery from other diseases that deserve conservative treatment or follow-up. The Pancreas Unit of Department of Surgery is a unit with an extensive experience in the treatment of pancreatic cancer and benign pancreatic diseases, with state-of-the-art technology to provide the best treatment for our patients, including minimally invasive surgery (laparoscopy). Since 2000, about 1800 pancreatic resections were perfomed, with more than 1000 pancreaticoduodenectomies. In addition, the Institute offers a wide expertise also by other non-surgical specialists (endoscopy, radiology, medical oncology, radiation therapy, and pathology), to provide the appropriate skills for the diagnosis, treatment and research in the field of pancreatic diseases.

Main treated diseases

  • Pancreatic cancer
  • Neuro-Endocrine Tumors (NETs)
  • Pancreatic cysts
  • Intraductal Papillary Mucinous Neoplasia (IPMN)
  • Acute pancreatitis
  • Chronic pancreatitis
  • Pancreatic pseudocysts

Main surgical operations

  • Pancreaticoduodenectomy
  • Distal pancreatectomy
  • Total pancreatectomy
  • Intermediate pancreatectomy
  • Enucleation of benign pancreatic tumors
  • Pancreatico-jejunostomy and pseudocyst-jejunostomy
  • Hepatico-jejunostomy and gastro-jejunostomy
  • Pancreatic Islets Autotransplantation

Research

Clinical and basic science research of our Unit has two main objectives: the improvement of the current results in the treatment of pancreatic cancer and the improvement of surgical technique, to further reduce the rate of postoperative complications of these interventions. For what concerns the treatment of pancreatic cancer, the most important studies are carried out in collaboration with the Departments of Medical Oncology and Gastroenterology. They concern the evaluation of new chemotherapeutic regimens, both preoperatively (neoadjuvant) and postoperatively (adjuvant), and the use of a new endoscopical treatment (cryotermoablation by EUS) for non-resectable pancreatic cancer. Other research activities of the Unit are carried out in close collaboration with basic science research groups. They are intended to develop future cancer treatments and involve the following topics: the isolation of stem cells from pancreatic cancer; the interaction between stroma and pancreatic cancer; the study of the immune response against pancreatic cancer and the development of a anti-tumor vaccine. For what concerns the improvement of technique, we are devoted to reduce the impact of pancreatic surgery, in terms of operative complications and long-term consequences of pancreatic surgery. In order to improve postoperative long-term glycaemic control, we are investigating the outcome of pancreatic islets autotransplantation in operations in which a portion of the pancreas (a portion not affected by neoplasm) must be removed for technical reasons. Further, we are studying the effects of clinical protocols to enhance the recovery after pancreatic surgery and in this context we have adopted the laparoscopic technique for most of the resections of the left portion of the pancreas (distal pancreatectomy).

Technology

The Pancreatic Surgery Unit of Ospedale San Raffaele is the only italian center providing the cell technology of pancreatic islets auto-transplantation, aiming to improve the glycaemic control after extensive pancreatic resections. Minimally invasive pancreatic surgery, especially distal pancreatectomy with or without spleen preservation, is routinely performed (in recent years, more than 150 laparoscopic distal pancreatectomies were performed). The Gastrointestinal Endoscopy Division has one of the highest volume of Endoscopic Ultrasonography for pancreatic diseases, offering the possibility of a minimally invasive local treatment in case of locally advanced, non-metastatic pancreatic cancer (EUS-guided cryothermal ablation).

Staff

Massimo Falconi, MD, Chief of the Pancreatic Surgery Unit and Professor of Surgery at San Raffaele Vita-Salute University School of Medicine, Gianpaolo Balzano, MD, Stefano Crippa, MD, PhD Stefano Partelli, MD, PhD.