Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2017; 23(35): 6457-6466
Published online Sep 21, 2017. doi: 10.3748/wjg.v23.i35.6457
Duodenum and ventral pancreas preserving subtotal pancreatectomy for low-grade malignant neoplasms of the pancreas: An alternative procedure to total pancreatectomy for low-grade pancreatic neoplasms
Xing Wang, Chun-Lu Tan, Hai-Yu Song, Qiang Yao, Xu-Bao Liu
Xing Wang, Chun-Lu Tan, Hai-Yu Song, Xu-Bao Liu, Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Qiang Yao, West China School of Public Health, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Wang X and Liu XB designed the research; Wang X, Tan CL and Yao Q performed the research and analyzed the data; Wang X, Tan CL and Song HY wrote the paper; Liu XB proofread and revised the manuscript; all authors approved the version to be published.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xu-Bao Liu, MD, PhD, Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu 610041, Sichuan Province, China. xbliu@medmail.com.cn
Telephone: +86-28-85422477 Fax: +86-28-85422474
Received: June 13, 2017
Peer-review started: June 16, 2017
First decision: July 17, 2017
Revised: July 27, 2017
Accepted: August 15, 2017
Article in press: August 15, 2017
Published online: September 21, 2017
Abstract
AIM

To describe the indications, technique and outcomes of the novel surgical procedure of duodenum and ventral pancreas preserving subtotal pancreatectomy (DVPPSP).

METHODS

Data collected retrospectively from 43 patients who underwent DVPPSP and TP between 2009 and 2015 in our single centre were analysed. For enrolment, only patients with low-grade pancreatic neoplasms, such as pancreatic neuroendocrine tumors, intraductal papillary mucinous neoplasms (IPMNs), and solid pseudo-papillary tumors, were included. Ten DVPPSP (group 1) and 13 TP (group 2) patients were selected in this study.

RESULTS

There were no significant differences in age, gender, comorbidities, preoperative symptoms, American Society of Anesthesiologists score or indications for surgery between the two groups. The most common indication was IPMN for DVPPSP and TP (60% vs 85%, P = 0.411). Compared with the TP group, the DVPPSP group had comparable postoperative morbidities (P = 0.405) and mortalities (both nil), but significantly shorter operative time (232 ± 19.6 min vs 335 ± 32.3 min, P < 0.001). DVPPSP preserved better long-term pancreatic function with less supplementary therapy (P < 0.001) and better quality of life (QoL) after surgery, including better scores in social (P = 0.042) and global health (P = 0.047) on functional scales and less appetite loss (P = 0.049) on the symptom scale.

CONCLUSION

DVPPSP is a feasible and safe procedure that could be an alternative to TP for low-grade neoplasms arising from the body and tail region but across the neck region of the pancreas; DVPPSP had better metabolic function and QoL after surgery.

Keywords: Low-grade malignant neoplasm, Ventral pancreas preserving, Subtotal pancreatectomy, Quality of life

Core tip: Although total pancreatectomy (TP) can be performed safely, the long-term metabolic complications prevent its application. Herein, we report our experience of duodenum and ventral pancreas preserving subtotal pancreatectomy (DVPPSP), which could be an alternative procedure to TP for low-grade pancreatic neoplasms, with a focus on the surgical indications, techniques and outcomes. Our results indicate that DVPPSP is a feasible and safe procedure that could be an alternative to TP for low-grade neoplasms arising from the body and tail region but across the neck region of the pancreas, with a better metabolic function and quality of life after surgery.