Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2020; 12(12): 491-506
Published online Dec 27, 2020. doi: 10.4240/wjgs.v12.i12.491
Partial pancreatic tail preserving subtotal pancreatectomy for pancreatic cancer: Improving glycemic control and quality of life without compromising oncological outcomes
Li You, Lie Yao, Yi-Shen Mao, Cai-Feng Zou, Chen Jin, De-Liang Fu
Li You, Lie Yao, Yi-Shen Mao, Cai-Feng Zou, Department of Pancreatic Surgery, Huashan Hospital, Shanghai 200040, China
Chen Jin, Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai 200040, China
Author contributions: You L and Fu DL designed the study; You L wrote the manuscript; You L, Yao L, Mao YS, and Zou CF collected the data and performed the statistical analysis; Yao L, Jin C, and Fu DL prepared the final version of the manuscript and designed the tables and figures; Yao L helped draft the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Huashan Hospital Affiliated to Fudan University (Approval No. KY 2019-566).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We declare that we have no conflicts of interest related to this study.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: De-Liang Fu, MD, PhD, Chairman, Professor, Surgeon, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, No. 12 Central Urumqi Road, Shanghai 200040, China. surgeonfu@163.com
Received: June 30, 2020
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
Abstract
BACKGROUND

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.

AIM

To evaluate the efficacy of PPTP-SP for patients with pancreatic cancer.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Partial pancreatic tail preserving subtotal pancreatectomy; Total pancreatectomy; Pancreatic cancer; Treatment outcome; Diabetes mellitus; Quality of life

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.