Clinical outcomes of organ-preserving pancreatectomy for benign or low-grade malignant pancreatic tumors: A multicenter nationwide survey in Japan.

Abstract

BACKGROUND/PURPOSE:

Whether organ-preserving pancreatic surgery has an advantage in postoperative short- and long-term outcomes or not is still unknown because only small case series studies have been available to date. In this multicenter retrospective study, we aimed to elucidate the clinical advantage and disadvantage of organ-preserving pancreatectomy among patients with low-grade malignant pancreatic tumors and benign pancreatic diseases.

METHODS:

We included patients diagnosed with benign or low-malignant pancreatic tumor who underwent pancreaticoduodenectomy (PD) in 621 cases, duodenum-preserving pancreatic head resection (DPPHR) in 31 cases, middle pancreatectomy (MP) in 148 cases, distal pancreatectomy (DP) in 814 cases, and spleen-preserving distal pancreatectomy (SPDP) in 259 cases between January 1, 2013, and December 31, 2017. Preoperative backgrounds, surgical outcomes and pre- and postoperative (3, 6, 12, 24, and 36 months) nutritional status were compared between these procedures.

RESULTS:

In terms of short-term outcomes, the incidence of pancreatic fistula in patients who underwent MP was significantly higher than in patients with standard pancreatectomy. As for the long-term pancreatic functions in the cases of head or body lesion, both exocrine and endocrine functions after MP were significantly favorable compared with the PD group from 3 to 36 months after surgery. In pancreatic body or tail lesion, significant advantage of endocrine function, but not exocrine function, was found in the MP group compared to standard DP at all time points.

CONCLUSIONS:

MP may contribute to the improvement of postoperative quality of life for patients with pancreatic body low-malignant tumors, rather than PD or DP; however, reducing the incidence of short-term complications such as pancreatic fistula is a future challenge.

• Authors: Yukio Asano, Hiroyuki Kato, Satoshi Arakawa, Masahiro Ito, Takukazu Nagakawa, Akimasa Nakao, Tetsuo Ohta, Hiroki Yamaue, Masakazu Yamamoto, Sohei Satoi, Yasuhiro Kodera, Yoshifumi Takeyama, Masayuki Ohtsuka, Itaru Endo, Tadahiro Takada, Akihiko Horiguchi
• Journal: Journal of hepato-biliary-pancreatic sciences (J Hepatobiliary Pancreat Sci) Vol. 29 Issue 8 Pg. 898-910 (Aug 2022) ISSN: 1868-6982 [Electronic] Japan
• PMID: 35437919 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2022 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Topics

• Humans
• Japan
• Pancreatectomy
• Pancreatic Fistula
• Pancreatic Neoplasms
• Pancreaticoduodenectomy
• Postoperative Complications
• Quality of Life
• Retrospective Studies
• Treatment Outcome
• Pancreatic Neoplasms