Extensive distal pancreatectomy (ExDP) is a novel surgical option for central pancreatic cancer

Abstract

M. Nakamura , T. Ohtsuka , H. Nakashima , K. Tsutsumi , S. Takahata , M. Tanaka . Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Japan Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Background: Distal pancreatectomy (DP) is a reasonable surgical treatment for pancreatic body cancer, because cancer of the pancreatic body tends to invade the neural plexus and lymphatic tissue around the splenic artery. However, since the right border of transection in DP is limited by the gastroduodenal artery (GDA) or the superior pancreaticoduodenal arteries (SPDAs), total pancreatectomy and pancreaticoduodenectomy are often performed for pancreatic cancer in the central pancreas between PV and splenic artery. We report our experience of a novel surgical method, extensive distal pancreatectomy (ExDP). In ExDP, we transected the pancreas at the right side of the GDA after cutting the GDA or SPDAs. Methods: We retrospectively analyzed our experience of 8 patients who underwent ExDP as a curative surgical operation for central pancreatic cancer. Results: Perioperative outcome of ExDP was as follows, median blood loss 307g, median operation time 254min, median hospital stay 21 days and pancreatic fistula of grade B defined by ISGPF in one patient. In terms of curability, 7 out of 8 patients underwent R0 resection. Negative intraoperative frozen section diagnosis changed to positive by permanent section histology in a patient. Diabetes was not deteriorated in 7 of the 8 patients. Conclusions: ExDP is a function-preserving operation for the treatment of central pancreatic cancer with favorable curability.