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