Organ preserving pancreatic resections offers better long-term conservation of pancreatic function at the expense of significantly high perioperative major morbidity: A fair trade-off for benign or low malignant potential pancreatic neoplasms

Abstract

Standard pancreatic resections often remove excess pancreatic parenchyma than required for tumors of low malignant potential (LMP) or benign neoplasms. We aimed to compare short and long-term outcomes following organ-ppreserving pancreatic resections (OPPAR) and standard pancreatic resections (SPR). Data was collected from a prospectively maintained database of patients who underwent OPPAR or SPR for benign or LMP pancreatic tumors from January 2011 to January 2020 at Tata Memorial Hospital. 40 and 110 patients were identified in OPPAR and SPR groups respectively. The mean surgery duration (277 vs. 339 minutes, p=0.006) and mean blood loss (602 vs 937 mL, p=0.01) were significantly lower in patients who underwent OPPAR. Although the overall morbidity (57.5% vs 43.6%, p=0.13) was comparable, the major morbidity (42.5% vs 20.9%, p=0.008), post-operative pancreatic fistula (POPF) (65% vs 33.6%, p=0.001) and clinically relevant POPF (42.5% vs. 19.1%, p=0.004) were significantly higher in OPPAR. After a median follow up of 29 months the post operative endocrine insufficiency (10% vs 15.5 %, p=0.39), exocrine insufficiency (20 % vs. 0%, p=0.002) and requirement of long-term pancreatic enzyme replacement (18.2% vs. 0%, p=0.004) were higher in SPRs. Left sided SPRs had higher endocrine insufficiency (17.1% vs. 11.2%, p=0.29) and right sided SPRs had higher exocrine insufficiency (20% vs. 8.6%, p=0.04). OPPAR should be considered for treatment of benign tumors and tumors of LMP with favorable features. Although the incidence of post-operative major morbidity and POPF is higher with OPPAR than standard resections, there appears to be long term functional benefit.