Value of central pancreatectomy in the treatment of benign and low-grade pancreatic malignant neoplasms

Abstract

Objective To explore the clinical application value of central pancreatectomy in the treatment of benign and low-grade pancreatic malignant neoplasms. Methods Clinical data of 23 patients (9 males, 14 females, age range: 16-59 years old, median age: 46 years old), who underwent central pancreatectomy and were diagnosed as benign or low-grade malignant neoplasms by postoperative pathological examinations in Department of General Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2006 to December 2011 were retrospectively analyzed. Five cases were insulinomas, 4 cases were solid pseudopapillary tumors, 4 cases were mucinous cystadenomas, 3 cases were serous cystadenomas, 3 cases were intraductal papillary mucinous tumors, 2 cases were pancreatic cysts, 1 case was nonfunctioning endocrine tumor and 1 case was hemangioma. The informed consents of all patients were obtained and the ethical committee approval was received. All patients received central pancreatectomy under tracheal intubation general anesthesia. The pancreas was transected about 1 cm away from both sides of neoplasm. The proximal end of pancreas was closed by U shape-suture or mattress-suture, and the main pancreatic duct was ligatured separately. The distal end of pancreas was anastomosed with stomach or jejunum. The volume of intraoperative blood loss, blood transfusion, operation length, postoperative blood glucose level and pancreatic fistula were observed. The patients were followed up after operation about tumor recurrence, quality of life and blood glucose level. Results The median volume of intraoperative blood loss was 159 ml(50-400 ml). One case received blood transfusion during operation. The median operation length was 225 min(149-386 min). No severe complication was observed in all patients. Elevated blood glucose level was found in 1 case after operation and remitted after symptomatic treatment. Pancreatic fistula was found in 11 cases(48%) with 10 cases of grade A pancreatic fistula and 1 case of grade B pancreatic fistula. The patients with grade A pancreatic fistula were self-cured without any treatment. The patient with grade B pancreatic fistula was cured by peritoneal lavage and anti-infective treatment. The postoperative follow-up length was 6 months to 5 years with the median of 23 months. One case was lost to follow-up, the other 22 cases survived without tumor recurrence. One case suffered from elevated blood glucose level 6 months after operation. The patient received oral hypoglycemic agents for 1 year and then stopped, the blood glucose level was kept normal. Three cases failed to regain body weight within half a year after operation, but no symptoms of dyspepsia were observed and no exogenous pancreaticenzyme replacement was used. Conclusion Central pancreatectomy is a safe and reasonable procedure for patients with benign or low-grade pancreatic malignant neoplasms. Key words: Pancreatectomy; Pancreatic neoplasms; Pancreatic fistula; Hyperglycemia; Neoplasm recurrence, local