You Li, Yao Lie, Mao Yi-Shen, Zou Cai-Feng, Jin Chen, Fu De-Liang
Department of Pancreatic Surgery, Huashan Hospital, Shanghai 200040, China.
Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
World J Gastrointest Surg. 2020 Dec 27;12(12):491-506. doi: 10.4240/wjgs.v12.i12.491.
Total pancreatectomy (TP) is usually considered a therapeutic option for pancreatic cancer in which Whipple surgery and distal pancreatectomy are undesirable, but brittle diabetes and poor quality of life (QoL) remain major concerns. A subset of patients who underwent TP even died due to severe hypoglycemia. For pancreatic cancer involving the pancreatic head and proximal body but without invasion to the pancreatic tail, we performed partial pancreatic tail preserving subtotal pancreatectomy (PPTP-SP) in selected patients, in order to improve postoperative glycemic control and QoL without compromising oncological outcomes.
To evaluate the efficacy of PPTP-SP for patients with pancreatic cancer.
We retrospectively reviewed 56 patients with pancreatic ductal adenocarcinoma who underwent PPTP-SP ( = 18) or TP ( = 38) at our institution from May 2014 to January 2019. Clinical outcomes were compared between the two groups, with an emphasis on oncological outcomes, postoperative glycemic control, and QoL. QoL was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 and EORTC PAN26). All patients were followed until May 2019 or until death.
A total of 56 consecutive patients were enrolled in this study. Perioperative outcomes, recurrence-free survival, and overall survival were comparable between the two groups. No patients in the PPTP-SP group developed cancer recurrence in the pancreatic tail stump or splenic hilum, or a clinical pancreatic fistula. Patients who underwent PPTP-SP had significantly better glycemic control, based on their higher rate of insulin-independence ( = 0.014), lower hemoglobin A1c (HbA1c) level ( = 0.046), lower daily insulin dosage ( < 0.001), and less frequent hypoglycemic episodes ( < 0.001). Global health was similar in the two groups, but patients who underwent PPTP-SP had better functional status ( = 0.036), milder symptoms ( = 0.013), less severe diet restriction ( = 0.011), and higher confidence regarding future life ( = 0.035).
For pancreatic cancer involving the pancreatic head and proximal body, PPTP-SP achieves perioperative and oncological outcomes comparable to TP in selected patients while significantly improving long-term glycemic control and QoL.
全胰切除术（TP）通常被视为胰腺癌的一种治疗选择，适用于无法进行Whipple手术和胰体尾切除术的情况，但脆性糖尿病和生活质量（QoL）差仍是主要问题。一部分接受TP的患者甚至因严重低血糖死亡。对于累及胰头和胰体近端但未侵犯胰尾的胰腺癌患者，我们对部分患者实施了保留胰尾的次全胰切除术（PPTP-SP），以在不影响肿瘤学预后的前提下改善术后血糖控制和生活质量。
评估PPTP-SP治疗胰腺癌患者的疗效。
我们回顾性分析了2014年5月至2019年1月在我院接受PPTP-SP（n = 18）或TP（n = 38）的56例胰腺导管腺癌患者。比较两组的临床结局，重点关注肿瘤学结局、术后血糖控制和生活质量。使用欧洲癌症研究与治疗组织生活质量问卷（EORTC QLQ-C30和EORTC PAN26）评估生活质量。所有患者随访至2019年5月或直至死亡。
本研究共纳入56例连续患者。两组的围手术期结局、无复发生存率和总生存率相当。PPTP-SP组无患者在胰尾残端或脾门发生癌症复发，也无临床胰瘘发生。接受PPTP-SP的患者血糖控制明显更好，表现为胰岛素独立性更高（P = 0.014）、糖化血红蛋白（HbA1c）水平更低（P = 0.046）、每日胰岛素剂量更低（P < 0.001）以及低血糖发作频率更低（P < 0.001）。两组的总体健康状况相似，但接受PPTP-SP的患者功能状态更好（P = 0.036）、症状更轻（P = 0.013）、饮食限制不那么严格（P = 0.011）且对未来生活的信心更高（P = 0.035）。
对于累及胰头和胰体近端的胰腺癌，PPTP-SP在部分患者中可实现与TP相当的围手术期和肿瘤学结局，同时显著改善长期血糖控制和生活质量。
