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Pancreatic Tumors


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The pancreas is made of 2 components and has integrated functions, exocrine pancreas and endocrine pancreas (islets of Langerhans). The exocrine pancreas is responsible for the production of pancreatic juice and enzymes involved in digestion, while the endocrine pancreas is responsible for the production of specific hormones regulators of some key metabolic pathways in the body. The tumor that most frequently develops in the exocrine pancreas is pancreatic adenocarcinoma.


pancreas center italyOur mission is to provide comprehensive care for patients with neoplastic and inflammatory diseases of the pancreas. The Verona Pancreas Institute surgical program provides the largest pancreatic neoplasms practice in Italy, and includes certified surgeons who specialize in performing surgery of the pancreas and biliary system.
We hold multidisciplinary meetings on a weekly basis that are attended by specialists from across the Pancreas Institute.
This collaboration provides continuative input that helps us deliver the best available care for our patients.
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Why do pancreas treatment in italy?

• The importance of expertise in pancreatic surgery: in pancreas surgery, more than any other surgery branch, it is demonstrated that accumulated experience in the years (in terms of surgical volume) is positively correlated with results, keeping in mind that pancreas interventions are technically complex procedures associated to high level difficulties and a mortality rate superior to many other major surgical procedures. For more information, click here.

• A multidisciplinary approach to pathologies of pancreas: our surgical unit is part of the Institute of Pancreas of Verona, Italy’s first center entirely dedicated to diagnosis and therapy of pancreatic diseases. A multidisciplinary team composed of surgeons, gastroenterologists, radiologists, oncologists and anatomo-patologists working together, integrating their knowledge and putting them to the service of patients’ needs.
• The use of the most advanced technologies: in Verona the most advanced technologies are used to produce diagnosis and cures of the diseases of pancreas. Particularly, a mini-invasive surgical procedure is active, both with videolaparoscopic technique and robot-assisted.

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Videolaparoscopic surgery is built on the principle of access to abdominal cavity using small incisions (between 5 and 15mm) and, through them a digital camera capable of projecting images in a screen is inserted along with thin tools to execute the surgical intervention. Developed in the end of the ‘80s, it has had more and more success, the indications widened to cover almost all the interventions in abdominal surgery, and the techniques have been standardized.
The main advantage of videolaparoscopic technique application is the reduction of the surgical trauma, which does not only have positive repercussion on an esthetic level. A trauma of minor entity also benefits the postsurgical recovery (usually faster and less painful), on the time to return to normal activity, and on the incidence of complications connected to the surgical incision, both in long and short term hernias.
The application of videolaparoscopic techniques on pancreas was kind of late, because of the anatomic site and the technical complexity of resection interventions. Initially the videolaparoscopy approach was especially proposed to patients with neoplasias slightly aggressive or not, because of a lack of data on the oncological adequacy of the intervention (i.e. the number of removed lymph node) and on long term outcomes. The published studies have shown that there is no difference in terms of radical oncology between traditional approach and mini-invasive approach. Laparoscopic surgery of the pancreas can consequently be proposed – considering every single case – even in the suspect of an aggressive neoplasia. Any pancreatic resection intervention can be performed with a laparoscopy. Left (or distal) pancreatectomy and enucleations are the most frequently performed interventions; the experience on intermediate pancreatectomy and on pancreaticoduodenectomy is more limited. In Verona a pancreatic laparoscopy program is active since 2000.
Robo-assisted (or robotic) surgery is an even more recent evolution of mini-invasive surgery; the first U.S.A. approval for a robotic system to enter in clinical practice was in 2000. The surgeon is in the operation room but physically distant from the patient, and sits in front of a console equipped with a 3D monitor. The console has a complex command system with which robotic arms simulate hands’ movement. The robotic arms are equipped with one attached camera along with various surgical instruments (which can count on sophisticated articulation systems with seven degrees of freedom) that are inserted in the abdominal cavity using small incisions, the same as what happens in videolaparoscopic surgery.
Pancreatic robo-assisted surgery is extremely complex, it was introduced in specialist centers since a few years. The experiences are still preliminary and only involve selected patients, but there is an always growing number of operated cases, with promising results. A robotic surgery of the pancreas program is active in Verona since 2012 with the Intuitive Surgical DaVinci-Si HD vision, just acquired by Azienda Ospedaliera Universitaria Integrata... 

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