Preoperative Investigations and Preparation for the Procedure

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History: Endocrine syndrome (hypoglycemia, acute pancreatitis, upper abdominal pain) Clinical evaluation: Exclude diarrhea secondary to exocrine insufficiency, diabetes, and signs of portal hypertension Laboratory tests: Amylase, lipase, and/or peptide hormones (insulin, gastrin, glucagon, vasoactive intestinal polypeptide, pancreatic polypeptide, somatostatin, chromogranin A), tumor markers (CA 19-9, CEA, MCA, etc.). If an endocrine neoplasm is suspected, store a preoperative sample of serum and/or plasma for specific assays based on histologic and immuno-histochemical characterization of the resected lesion Imaging: Differential diagnosis and assessment of resectability based on ultrasonography, computed tomography, magnetic resonance imaging, or endoscopic ultrasonography

- 111In-pentetreotide scintigraphy (OctreoScan): endocrine neoplasms

- Positron emission tomography (PET): differentiates between benign and malignant lesions

Preoperative preparation: - Somatostatin analogues: no specific study on central pancreatectomy

- Perioperative antibiotics: as for any clean-contaminated operation

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