{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T17:03:42Z","timestamp":1767891822890,"version":"3.49.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T00:00:00Z","timestamp":1656288000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T00:00:00Z","timestamp":1656288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["surg case rep"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Severely obese patients can have other diseases requiring surgical treatment. In such patients, bariatric surgeries are considered a precursor to operations targeting the original disease for the purpose of reducing severe perioperative complications. Pancreatic ectopic fat deposition increases pancreas volume (PV) and thickness, which can worsen insulin resistance and islet \u03b2 cell function. To address this problem, we present a novel two-stage surgical strategy performed on a severely obese patient with pancreatic neuroendocrine tumor (PNET) consisting of laparoscopic sleeve gastrectomy (LSG) as a metabolic surgery followed by laparoscopic spleen-preserving distal pancreatectomy (LSPDP).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 56-year-old man was referred to our hospital for further investigation of a pancreatic tumor. His initial body weight and body mass index (BMI) were 94.0\u00a0kg and 37.2\u00a0kg\/m<jats:sup>2<\/jats:sup>, respectively. Contrast computed tomography revealed an enhanced tumor measuring 15\u00a0mm on the pancreatic body. The pancreas thickness and PV were 32\u00a0mm and 148\u00a0mL, respectively. An endoscopic ultrasonographic fine needle aspiration identified the tumor as PNET-G1. We first performed LSG, the patient\u2019s body weight and BMI had decreased dramatically to 64.0\u00a0kg and 25.3\u00a0kg\/m<jats:sup>2<\/jats:sup> at 6\u00a0months after LSG. The pancreas thickness and PV had also decreased to 17\u00a0mm and 99\u00a0mL, respectively, with no tumor growth. Since LSG has been shown to reduce the perioperative risk factors of LSPDP, and to improve insulin resistance and recovery of islet \u03b2 cell function, we performed LSPDP for PNET-G1 as a second-stage surgery. The postoperative course was unremarkable, and the patient was discharged on postoperative day 14 without symptomatic postoperative pancreatic fistula (POPF). He was followed without recurrence or type 2 diabetes (T2D) onset for 6\u00a0months after LSPDP.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We present a novel two-stage surgical strategy for a severely obese patient with PNET, consisting of LSG as a metabolic surgery for severe obesity, followed by LSPDP after confirmation of good weight loss and metabolic effects. LSG before pancreatectomy may have a potential to reduce pancreas thickness and recovery of islet \u03b2 cell function in severely obese patients, thereby reducing the risk of clinically relevant POPF and post-pancreatectomy T2D onset.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40792-022-01484-9","type":"journal-article","created":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T03:14:23Z","timestamp":1656299663000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A novel second-stage surgical strategy for severely obese patient with pancreatic neuroendocrine tumor: a case report"],"prefix":"10.1186","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4181-7159","authenticated-orcid":false,"given":"Akira","family":"Umemura","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akira","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyuki","family":"Nitta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirokatsu","family":"Katagiri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shoji","family":"Kanno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daiki","family":"Takeda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taro","family":"Ando","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Amano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masao","family":"Nishiya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noriyuki","family":"Uesugi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamotsu","family":"Sugai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,6,27]]},"reference":[{"key":"1484_CR1","doi-asserted-by":"publisher","first-page":"255","DOI":"10.3748\/wjg.v11.i2.255","volume":"11","author":"H Sakugawa","year":"2005","unstructured":"Sakugawa H, Nakayoshi T, Kobashigawa K, Yamashiro T, Maeshiro T, Miyagi S, et al. Clinical usefulness of biochemical markers of liver fibrosis in patients with nonalcoholic fatty liver disease. World J Gastroenterol. 2005;11:255\u20139.","journal-title":"World J Gastroenterol"},{"key":"1484_CR2","doi-asserted-by":"publisher","first-page":"1831","DOI":"10.1007\/s11695-022-06036-6","volume":"32","author":"R Otake","year":"2022","unstructured":"Otake R, Seki Y, Kasama K, Yokoyama R, Kurokawa Y, Tani M. Long-term impact of laparoscopic sleeve gastrectomy on drug costs of Japanese patients with obesity and type 2 diabetes mellitus. Obes Surg. 2022;32:1831\u201341.","journal-title":"Obes Surg"},{"key":"1484_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s13340-021-00551-0","volume":"13","author":"A Sasaki","year":"2021","unstructured":"Sasaki A, Yokote K, Naitoh T, Fujikura J, Hayashi K, Hirota Y, et al. Metabolic surgery in treatment of obese Japanese patients with type 2 diabetes: a joint consensus statement from the Japanese Society for Treatment of Obesity, the Japan Diabetes Society, and the Japan Society for the Study of Obesity. Diabetol Int. 2021;13:1\u201330.","journal-title":"Diabetol Int"},{"key":"1484_CR4","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1016\/j.soard.2013.11.002","volume":"10","author":"KJ Wikiel","year":"2014","unstructured":"Wikiel KJ, McCloskey CA, Ramanathan RC. Bariatric surgery: a safe and effective conduit to cardiac transplantation. Surg Obes Relat Dis. 2014;10:479\u201384.","journal-title":"Surg Obes Relat Dis"},{"key":"1484_CR5","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1111\/ases.12260","volume":"9","author":"Y Shioi","year":"2016","unstructured":"Shioi Y, Sasaki A, Nitta H, Umemura A, Baba S, Iwaya T, et al. Two-stage surgery to repair a dissecting abdominal aortic aneurysm in a severely obese patient: open bifurcated graft replacement after laparoscopic sleeve gastrectomy. Asian J Endosc Surg. 2016;9:149\u201351.","journal-title":"Asian J Endosc Surg"},{"key":"1484_CR6","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1038\/s41575-021-00551-0","volume":"19","author":"MS Petrov","year":"2022","unstructured":"Petrov MS, Taylor R. Intra-pancreatic fat deposition: bringing hidden fat to the fore. Nat Rev Gastroenterol Hepatol. 2022;19:153\u201368.","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"1484_CR7","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1507\/endocrj.EJ16-0321","volume":"64","author":"A Umemura","year":"2017","unstructured":"Umemura A, Sasaki A, Nitta H, Baba S, Ando T, Kajiwara T, et al. Pancreas volume reduction and metabolic effects in Japanese patients with severe obesity following laparoscopic sleeve gastrectomy. Endocr J. 2017;64:487\u201398.","journal-title":"Endocr J"},{"key":"1484_CR8","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1507\/endocrj.EJ13-0524","volume":"61","author":"A Umemura","year":"2014","unstructured":"Umemura A, Sasaki A, Nitta H, Otsuka K, Suto T, Wakabayashi G. Effects of changes in adipocyte hormones and visceral adipose tissue and the reduction of obesity-related comorbidities after laparoscopic sleeve gastrectomy in Japanese patients with severe obesity. Endocr J. 2014;61:381\u201391.","journal-title":"Endocr J"},{"key":"1484_CR9","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.advms.2015.10.001","volume":"61","author":"R Pezzilli","year":"2016","unstructured":"Pezzilli R, Partelli S, Cannizzaro R, Pagano N, Crippa S, Pagnanelli M, et al. Ki-67 prognostic and therapeutic decision driven marker for pancreatic neuroendocrine neoplasms (PNENs): a systematic review. Adv Med Sci. 2016;61:147\u201353.","journal-title":"Adv Med Sci"},{"key":"1484_CR10","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1016\/j.gie.2009.12.023","volume":"71","author":"T Ishikawa","year":"2010","unstructured":"Ishikawa T, Itoh A, Kawashima H, Ohno E, Matsubara H, Itoh Y, et al. Usefulness of EUS combined with contrast-enhancement in the differential diagnosis of malignant versus benign and preoperative localization of pancreatic endocrine tumors. Gastrointest Endosc. 2010;71:951\u20139.","journal-title":"Gastrointest Endosc"},{"key":"1484_CR11","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1007\/s11695-009-9873-z","volume":"19","author":"K Kasama","year":"2009","unstructured":"Kasama K, Tagaya N, Kanehira E, Oshiro T, Seki Y, Kinouchi M, et al. Laparoscopic sleeve gastrectomy with duodenojejunal bypass: technique and preliminary results. Obes Surg. 2009;19:1341\u20135.","journal-title":"Obes Surg"},{"key":"1484_CR12","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1001\/archsurg.2010.326","volume":"146","author":"WJ Lee","year":"2011","unstructured":"Lee WJ, Chong K, Ser KH, Lee YC, Chen SC, Chen JC, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146:143\u20138.","journal-title":"Arch Surg"},{"key":"1484_CR13","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1007\/s11695-017-2874-4","volume":"28","author":"T Naitoh","year":"2018","unstructured":"Naitoh T, Kasama K, Seki Y, Ohta M, Oshiro T, Sasaki A, et al. Efficacy of sleeve gastrectomy with duodenal-jejunal bypass for the treatment of obese severe diabetes patients in japan: a retrospective multicenter study. Obes Surg. 2018;28:497\u2013505.","journal-title":"Obes Surg"},{"key":"1484_CR14","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1038\/s41574-021-00573-3","volume":"18","author":"R Wagner","year":"2022","unstructured":"Wagner R, Eckstein SS, Yamazaki H, Gerst F, Machann J, Jaghutriz BA, et al. Metabolic implications of pancreatic fat accumulation. Nat Rev Endocrinol. 2022;18:43\u201354.","journal-title":"Nat Rev Endocrinol"},{"key":"1484_CR15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0177154","volume":"12","author":"SD Heber","year":"2017","unstructured":"Heber SD, Hetterich H, Lorbeer R, Bayerl C, Machann J, Auweter S, et al. Pancreatic fat content by magnetic resonance imaging in subjects with prediabetes, diabetes, and controls from a general population without cardiovascular disease. PLoS ONE. 2017;12: e0177154.","journal-title":"PLoS ONE"},{"key":"1484_CR16","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1159\/000519621","volume":"15","author":"J Ko","year":"2022","unstructured":"Ko J, Skudder-Hill L, Priya S, Kimita W, Bharmal SH, Petrov MS. Associations between intra-pancreatic fat deposition, pancreas size, and pancreatic enzymes in health and after an attack of acute pancreatitis. Obes Facts. 2022;15:70\u201382.","journal-title":"Obes Facts"},{"key":"1484_CR17","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1097\/MPA.0000000000001957","volume":"51","author":"S Shintani","year":"2022","unstructured":"Shintani S, Inatomi O, Bamba S, Takeda Y, Fujimoto T, Ota S, et al. Larger volume and higher fat content of the pancreatic head are predictive factors for postendoscopic retrograde cholangiopancreatography pancreatitis. Pancreas. 2022;51:28\u201334.","journal-title":"Pancreas"},{"key":"1484_CR18","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.ejrad.2019.06.024","volume":"118","author":"H Fukui","year":"2019","unstructured":"Fukui H, Hori M, Fukuda Y, Onishi H, Nakamoto A, Ota T, et al. Evaluation of fatty pancreas by proton density fat fraction using 3-T magnetic resonance imaging and its association with pancreatic cancer. Eur J Radiol. 2019;118:25\u201331.","journal-title":"Eur J Radiol"},{"key":"1484_CR19","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1007\/s00595-017-1554-2","volume":"48","author":"H Kawaida","year":"2018","unstructured":"Kawaida H, Kono H, Watanabe M, Hosomura N, Amemiya H, Fujii H. Risk factors of postoperative pancreatic fistula after distal pancreatectomy using a triple-row stapler. Surg Today. 2018;48:95\u2013100.","journal-title":"Surg Today"},{"key":"1484_CR20","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1007\/s00464-020-07912-x","volume":"35","author":"G Zimmitti","year":"2021","unstructured":"Zimmitti G, La Mendola R, Manzoni A, Sega V, Malerba V, Treppiedi E, et al. Investigation of intraoperative factors associated with postoperative pancreatic fistula following laparoscopic left pancreatectomy with stapled closure: a video review-based analysis: video-review for predictors of pancreatic leak. Surg Endosc. 2021;35:941\u201354.","journal-title":"Surg Endosc"},{"key":"1484_CR21","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1177\/0003134820952429","volume":"87","author":"YM Bag","year":"2021","unstructured":"Bag YM, Topel C, Ozdemir E, Saglam K, Sumer F, Kayaalp C. A novel radiological predictor for postoperative pancreatic fistula after stapled distal pancreatectomy. Am Surg. 2021;87:725\u201331.","journal-title":"Am Surg"},{"key":"1484_CR22","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1016\/S1499-3872(15)60399-X","volume":"14","author":"F Elabbasy","year":"2015","unstructured":"Elabbasy F, Gadde R, Hanna MM, Sleeman D, Livingstone A, Yakoub D. Minimally invasive spleen-preserving distal pancreatectomy: does splenic vessel preservation have better postoperative outcomes? A systematic review and meta-analysis. Hepatobiliary Pancreat Dis Int. 2015;14:346\u201353.","journal-title":"Hepatobiliary Pancreat Dis Int"},{"key":"1484_CR23","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1002\/jso.24507","volume":"115","author":"F Pendola","year":"2017","unstructured":"Pendola F, Gadde R, Ripat C, Sharma R, Picado O, Lobo L, et al. Distal pancreatectomy for benign and low grade malignant tumors: short-term postoperative outcomes of spleen preservation\u2014a systematic review and update meta-analysis. J Surg Oncol. 2017;115:137\u201343.","journal-title":"J Surg Oncol"},{"key":"1484_CR24","doi-asserted-by":"publisher","first-page":"3568","DOI":"10.3390\/nu13103568","volume":"13","author":"A Sutanto","year":"2021","unstructured":"Sutanto A, Wungu CDK, Susilo H, Sutanto H. Reduction of major adverse cardiovascular events (MACE) after bariatric surgery in patients with obesity and cardiovascular diseases: a systematic review and meta-analysis. Nutrients. 2021;13:3568.","journal-title":"Nutrients"},{"key":"1484_CR25","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1016\/j.soard.2019.12.027","volume":"16","author":"L Han","year":"2020","unstructured":"Han L, Han H, Wang L, Ruan Y, Wei X, He J, et al. Prior bariatric surgery is associated with lower complications, in-hospital mortality, and healthcare utilization after elective spine fusion surgery. Surg Obes Relat Dis. 2020;16:760\u20137.","journal-title":"Surg Obes Relat Dis"},{"key":"1484_CR26","doi-asserted-by":"publisher","first-page":"e101","DOI":"10.1016\/j.soard.2013.04.008","volume":"9","author":"Y Hasegawa","year":"2013","unstructured":"Hasegawa Y, Sasaki A, Nitta H, Wakabayashi G. Two-stage surgery in a morbidly obese patient: laparoscopic pylorus-preserving pancreaticoduodenectomy after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2013;9:e101-104.","journal-title":"Surg Obes Relat Dis"}],"container-title":["Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40792-022-01484-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40792-022-01484-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40792-022-01484-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T03:16:43Z","timestamp":1656299803000},"score":1,"resource":{"primary":{"URL":"https:\/\/surgicalcasereports.springeropen.com\/articles\/10.1186\/s40792-022-01484-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,27]]},"references-count":26,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["1484"],"URL":"https:\/\/doi.org\/10.1186\/s40792-022-01484-9","relation":{},"ISSN":["2198-7793"],"issn-type":[{"value":"2198-7793","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,27]]},"assertion":[{"value":"21 May 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 June 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 June 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from this patient to publish the details of the case.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"125"}}