Published online Sep 21, 2017. doi: 10.3748/wjg.v23.i35.6457
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
Processing time: 99 Days and 0.9 Hours
To describe the indications, technique and outcomes of the novel surgical procedure of duodenum and ventral pancreas preserving subtotal pancreatectomy (DVPPSP).
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.
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.
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.
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.