Which is less invasive--distal pancreatectomy or segmental resection?

BACKGROUND

For a pancreatic body tumor, distal pancreatectomy (DP) has been a standard operation. Segmental resection (SR) of the pancreas has been introduced as a less invasive procedure in consideration of preservation of the pancreatic functions and postoperative quality of life. Surgical stress and exocrine and endocrine functions of the residual pancreas were compared between DP and SR.

METHODS

Clinical findings including serum levels of C reactive protein (CRP), fasting blood sugar, a 120 min value of the 75 g oral glucose tolerance test, and N-benzol-L-tyrosyl-p-aminobenzoic acid excretion value (a pancreatic exocrine function test) were compared between 47 patients with DP and 10 with SR performed for benign pancreatic diseases.

RESULTS

Operation time was longer in SR (356 min) than in DP (272 min; P = 0.0123). Operative blood loss and peri-operative blood transfusion were not different between the two groups. Serum levels of CRP increased after the operation, reaching the peak on postoperative day 2 or 3, and decreased thereafter The peak of serum CRP level was similar between the two groups (13.4+/-1.8 mg/dl in SR and 14.8+/-1.1 mg/dl in DP). Postoperative hospital stay in 10 patients with SR (65 days) was significantly longer than that in 47 with DP (33 days; P = 0.0001). When postoperative complications were compared between the two groups, the incidence of pancreatic fistula was significantly higher in SR (4/10 [40%]) than in DP (4/46 [9%]; P = 0.0103). Abdominal abscess was seen in 30% of SR and in 11% of DP. Postoperative intra-abdominal hemorrhage was seen only in one patient with SR After DP, glucose tolerance deteriorated at short-term in nine of 24 patients examined and at long-term in two of five patients examined. Only one patient showed improvement of glucose intolerance at short-term after the operation. On the other hand, SR showed no alteration of the pancreatic endocrine and exocrine functions in eight patients examined.

CONCLUSIONS

SR is superior to DP from the view-point of preservation of the pancreatic functions, although SR has a longer operation time, a longer hospital stay and a higher incidence of postoperative complications.