Department of General and Visceral Surgery, University of Ulm, c/o Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
Department of Oncology, Endocrinology and Minimal-Invasive Surgery, Donau-Klinikum, 89231, Neu-Ulm, Germany.
J Gastrointest Surg. 2018 Mar;22(3):562-566. doi: 10.1007/s11605-017-3644-2. Epub 2018 Jan 3.
Pancreaticoduodenectomy and left-sided pancreatectomy are the surgical treatment standards for tumors of the pancreas. Surgeons, who are requested to treat patients with benign tumors, using standard oncological resections, face the challenge of sacrificing pancreatic and extra-pancreatic tissue. Tumor enucleation, pancreatic middle segment resection and local, duodenum-preserving pancreatic head resections are surgical procedures increasingly used as alternative treatment modalities compared to classical pancreatic resections. Use of local resection procedures for cystic neoplasms and neuro-endocrine tumors of the pancreas (panNETs) is associated with an improvement of procedure-related morbidity, when compared to classical Whipple OP (PD) and left-sided pancreatectomy (LP). The procedure-related advantages are a 90-day mortality below 1% and a low level of POPF B+C rates. Most importantly, the long-term benefits of the use of local surgical procedures are the preservation of the endocrine and exocrine pancreatic functions. PD performed for benign tumors on preoperative normo-glycemic patients is followed by the postoperative development of new onset of diabetes mellitus (NODM) in 4 to 24% of patients, measured by fasting blood glucose and/or oral/intravenous glucose tolerance test, according to the criteria of the international consensus guidelines. Persistence of new diabetes mellitus during the long-term follow-up after PD for benign tumors is observed in 14.5% of cases and after surgery for malignant tumors in 15.5%. Pancreatic exocrine insufficiency after PD is found in the long-term follow-up for benign tumors in 25% and for malignant tumors in 49%. Following LP, 14-31% of patients experience postoperatively NODM; many of the patients subsequently change to insulin-dependent diabetes mellitus (IDDM). The decision-making for cystic neoplasms and panNETs of the pancreas should be guided by the low surgical risk and the preservation of pancreatic metabolic functions when undergoing a limited, local, tissue-sparing procedure.
胰十二指肠切除术和胰体尾切除术是胰腺肿瘤的手术治疗标准。外科医生在治疗良性肿瘤患者时，采用标准的肿瘤切除术，面临着牺牲胰腺和胰外组织的挑战。肿瘤剜除术、胰中段切除术和局部保留十二指肠的胰头切除术等手术方法，与经典的胰腺切除术相比，越来越多地被用作替代治疗方法。对于胰腺囊性肿瘤和神经内分泌肿瘤（panNETs），与经典的胰十二指肠切除术（Whipple OP，PD）和胰体尾切除术（left-sided pancreatectomy，LP）相比，采用局部切除术与降低手术相关并发症发生率相关。局部手术的相关优势是 90 天死亡率低于 1%，POPF B+C 发生率较低。最重要的是，局部手术长期获益在于保留内分泌和外分泌胰腺功能。对于术前血糖正常的良性肿瘤患者行 PD 后，根据国际共识指南的标准，通过空腹血糖和/或口服/静脉葡萄糖耐量试验，4%至 24%的患者会出现新发糖尿病（NODM）。在 PD 治疗良性肿瘤的长期随访中，14.5%的患者会持续出现新的糖尿病，而在恶性肿瘤患者中则为 15.5%。在 PD 治疗良性肿瘤的长期随访中，发现胰腺外分泌功能不全的患者占 25%，在恶性肿瘤患者中占 49%。行 LP 后，14%-31%的患者术后出现 NODM；许多患者随后转为胰岛素依赖型糖尿病（IDDM）。对于胰腺囊性肿瘤和 panNETs 的治疗决策，应考虑手术风险低，同时保留胰腺代谢功能，选择有限的、局部的、保留组织的手术。
