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
ARTICLE HIGHLIGHTS
Research background

Total pancreatectomy (TP) is usually considered a therapeutic option for pancreatic cancers in which neither Whipple surgery nor distal pancreatectomy could achieve R0 resection. Although the morbidity and mortality after TP have decreased continuously, the postoperative glycemic disorder and poor quality of life (QoL) are still big problems. The brittle diabetes following TP may expose patients to life-threatening complications, and those with poor QoL are less likely to receive adjuvant chemotherapy.

Research motivation

Several methods were invented for alleviating the brittle diabetes following TP, but some of them are expensive, time-consuming, or ineffective. We wanted to develop an easy and effective method to prevent or minimize this intractable complication using surgical techniques.

Research objectives

The aim of this study was to evaluate the efficacy of partial pancreatic tail preserving- subtotal pancreatectomy (PPTP-SP) for patients with pancreatic cancer.

Research methods

Fifty-six consecutive patients who underwent TP or PPTP-SP for pancreatic cancer were enrolled in this retrospective study. The indications and surgical procedures have been elaborated in the article. Clinical outcomes were compared between the two groups (PPTP-SP vs TP), with an emphasis on oncological outcomes, postoperative glycemic control, and QoL.

Research results

PPTP-SP is indicated for patients selected from those usually considered as candidates for TP, and it is technically easy for skillful pancreatic surgeons. The perioperative outcomes were comparable between the two groups, as well as the long-term survival. Currently, no patients who underwent PPTP-SP developed cancer recurrence in the pancreatic tail stump or splenic hilum, or a clinical pancreatic fistula. Furthermore, those in the PPTP-SP group showed an evident glycemic advantage over those in the TP group, thus having better functional status, milder symptoms, less severe diet restriction, and higher confidence regarding future life.

Research conclusions

For treating pancreatic cancer, PPTP-SP could achieve perioperative and oncological outcomes comparable to those of TP in selected patients while providing significantly better long-term glycemic control and more satisfactory QoL.

Research perspectives

We hope that our study could give pancreatic surgeons throughout the world another option when treating pancreatic tumor in selected patients. Meanwhile, further research, ideally prospective randomized studies, with larger sample size and longer follow-up is needed to establish the generality of our findings.