Published online Dec 27, 2020. doi: 10.4240/wjgs.v12.i12.491
Peer-review started: June 30, 2020
First decision: September 18, 2020
Revised: September 30, 2020
Accepted: November 11, 2020
Article in press: November 11, 2020
Published online: December 27, 2020
Processing time: 174 Days and 6.3 Hours
Total pancreatectomy (TP) is usually considered a therapeutic option for pancreatic cancer in which Whipple surgery and distal pancreatectomy are undesirable, but brittle diabetes and poor quality of life (QoL) remain major concerns. A subset of patients who underwent TP even died due to severe hypoglycemia. For pancreatic cancer involving the pancreatic head and proximal body but without invasion to the pancreatic tail, we performed partial pancreatic tail preserving subtotal pancreatectomy (PPTP-SP) in selected patients, in order to improve postoperative glycemic control and QoL without compromising oncological outcomes.
To evaluate the efficacy of PPTP-SP for patients with pancreatic cancer.
We retrospectively reviewed 56 patients with pancreatic ductal adenocarcinoma who underwent PPTP-SP (n = 18) or TP (n = 38) at our institution from May 2014 to January 2019. Clinical outcomes were compared between the two groups, with an emphasis on oncological outcomes, postoperative glycemic control, and QoL. QoL was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 and EORTC PAN26). All patients were followed until May 2019 or until death.
A total of 56 consecutive patients were enrolled in this study. Perioperative outcomes, recurrence-free survival, and overall survival were comparable between the two groups. No patients in the PPTP-SP group developed cancer recurrence in the pancreatic tail stump or splenic hilum, or a clinical pancreatic fistula. Patients who underwent PPTP-SP had significantly better glycemic control, based on their higher rate of insulin-independence (P = 0.014), lower hemoglobin A1c (HbA1c) level (P = 0.046), lower daily insulin dosage (P < 0.001), and less frequent hypoglycemic episodes (P < 0.001). Global health was similar in the two groups, but patients who underwent PPTP-SP had better functional status (P = 0.036), milder symptoms (P = 0.013), less severe diet restriction (P = 0.011), and higher confidence regarding future life (P = 0.035).
For pancreatic cancer involving the pancreatic head and proximal body, PPTP-SP achieves perioperative and oncological outcomes comparable to TP in selected patients while significantly improving long-term glycemic control and QoL.
Core Tip: In order to improve postoperative glycemic control and quality of life (QoL) while ensuring safety and oncological efficacy, we performed partial pancreatic tail preserving subtotal pancreatectomy (PPTP-SP) as an alternative to total pancreatectomy in selected patients. No patients in the PPTP-SP group developed cancer recurrence in the pancreatic tail stump or splenic hilum, or a clinical pancreatic fistula. Although the exocrine function of the remnant pancreas almost completely degenerated, its endocrine function was preserved. Our long-term follow-up indicated that PPTP-SP achieved significantly better postoperative glycemic control and QoL without compromising oncological outcomes. Moreover, PPTP-SP could also be indicated for other pancreatic neoplasms.