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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2022; 14(9): 896-903
Published online Sep 27, 2022. doi: 10.4240/wjgs.v14.i9.896
Central pancreatectomy for benign or low-grade malignant pancreatic tumors in the neck and body of the pancreas
Yi-Wen Chen, Jian Xu, Xiang Li, Wei Chen, Shun-Liang Gao, Yan Shen, Min Zhang, Jian Wu, Ri-Sheng Que, Jun Yu, Ting-Bo Liang, Xue-Li Bai
Yi-Wen Chen, Jian Xu, Xiang Li, Wei Chen, Shun-Liang Gao, Yan Shen, Min Zhang, Jian Wu, Ri-Sheng Que, Jun Yu, Ting-Bo Liang, Xue-Li Bai, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Ting-Bo Liang, Xue-Li Bai, Department of Pancreatic Disease, Zhejiang Provincial Key Laboratory, Hangzhou 310000, Zhejiang Province, China
Ting-Bo Liang, Xue-Li Bai, The Study of Pancreatic Disease, Zhejiang Provincial Innovation Center, Hangzhou 310000, Zhejiang Province, China
Ting-Bo Liang, Xue-Li Bai, The Study of Hepatobiliary & Pancreatic Diseases, Zhejiang Provincial Clinical Research Center, Hangzhou 310003, Zhejiang Province, China
Ting-Bo Liang, Cancer Center, Zhejiang University, Hangzhou 310058, Zhejiang Province, China
Author contributions: Bai XL and Liang TB made equal contributions in conception of the study, and review and finalization of the manuscript; Chen YW, Xu J, Li X, Chen W, Gao SL, Shen Y, Zhang M, Wu J, and Yu J reviewed and collected the data; Chen Y and Xu J analyzed the data; Chen Y wrote the manuscript; and all authors approved the manuscript.
Supported by the National Natural Science Foundation of China, No. 82172859, 81801566, and 82071867; and the National Key Research and Development Program of China, No. 2019YFC1316000.
Institutional review board statement: This study was approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang University, School of Medicine (No. 2022-199).
Informed consent statement: Informed consent was exempted by the Ethics Committee of the First Affiliated Hospital of Zhejiang University, School of Medicine (No. 2022-199).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Xue-Li Bai, Doctor, MD, PhD, Chief Doctor, Professor, Surgeon, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310000, Zhejiang Province, China. shirleybai@zju.edu.cn
Received: March 15, 2022
Peer-review started: March 15, 2022
First decision: April 25, 2022
Revised: May 12, 2022
Accepted: August 12, 2022
Article in press: August 12, 2022
Published online: September 27, 2022
BACKGROUND
For tumors in the neck and body of the pancreas, distal pancreatectomy (DP) has been the standard surgical procedure for the last few decades and central pancreatectomy (CP) is an alternative surgical option. Whether CP better preserves remnant pancreatic endocrine and exocrine functions after surgery remains a subject of debate.
AIM
To evaluate the safety and efficacy of CP compared with DP for benign or low-grade malignant pancreatic tumors in the neck and body of the pancreas.
METHODS
This retrospective study enrolled 296 patients who underwent CP or DP for benign and low-malignant neoplasms at the same hospital between January 2016 and March 2020. Perioperative outcomes and long-term morbidity of endocrine/exocrine function were prospectively evaluated.
RESULTS
No significant difference was observed in overall morbidity or clinically relevant postoperative pancreatic fistula between the two groups (P = 0.055). Delayed gastric emptying occurred more frequently in the CP group than in the DP group (29.4% vs 15.3%; P < 0.005). None of the patients in the CP group had new-onset or aggravated distal metastasis, whereas 40 patients in the DP group had endocrine function deficiency after surgery (P < 0.05). There was no significant difference in the incidence of diarrhea immediately after surgery, but at postoperative 12 mo, a significantly higher number of patients had diarrhea in the DP group than in the CP group (0% vs 9.5%; P < 0.05).
CONCLUSION
CP is a generally safe procedure and is better than DP in preserving long-term pancreatic endocrine and exocrine functions. Therefore, CP might be a better option for treating benign or low-grade malignant neoplasms in suitable patients.
Core Tip: For tumors in the neck and body of the pancreas, distal pancreatectomy (DP) has been the standard surgical procedure for the last few decades, and central pancreatectomy (CP) is an alternative surgical option. It remains unclear whether CP can better preserve remnant pancreatic endocrine and exocrine functions. The results of this retrospective study provide evidence that CP is a generally safe procedure and is better than DP in preserving long-term pancreatic endocrine and exocrine functions.
