Clinical outcomes of radical surgery for pancreatic body and tail tumor accompanied with sinistral portal hypertension

Abstract

Objective To investigate the clinical outcomes of radical surgery for pancreatic body and tail tumors accompanied with sinistral portal hypertension (SPH). Method The clinicopathological data of 35 patients with pancreatic body and tail tumors accompanied with SPH operated from January 2004 to December 2014 were retrospectively analyzed. Results Of 35 patients, 22 patients had body and tail pancreatic carcinomas, 10 patients had malignant solid pesudopaillary tumors and 1 patients had a neuroendocrine tumor. All these patients developed splenomegaly and varices in the gastric fundus with normal hepatic function. The splenic vein pressure was (27.3±3.8)cmH2O (1 cmH2O=0.098 kPa), its average diameter was (1.3±0.3)cm, and the speed of splenic vein blood flow was (8.9±0.8)cm/s. Of the 35 patients with pancreatic body and tail tumors who underwent radical resectional operations, 22 patients in addition underwent devascularization. There were 13 of these 22 patients who underwent pericardical devascularization and the remaining 9 underwent total or proximal gastrectomy. The main complications were pancreatic fistula (n=5, 14.2%), intra-abdominal infection (n=4, 11.5%), delayed gastric emptying (n=1, 2.8%), lymphatic fistula (n=1, 2.8%) and gastric perforation (n=1, 2.8%). The post-complication morbidity rate was 34%. All these patients were followed-up for 6 to 60 months after operations. There was no upper gastrointestinal bleeding which occurred within 6 months of operation. Conclusion Multi-disciplinary treatment, complete preoperative evaluation, correct perioperative and individualized management enhanced efficacy in the surgical treatment of patients with pancreatic body and tail tumors with SPH. Key words: Pancreatic neoplasms; Hypertension, portal vein; Complication; Radical surgery