c/o University of Ulm, Ulm, Germany.
Center for Oncologic, Endocrine and Minimal Invasive Surgery, Donau-Klinikum, Neu-Ulm, Germany.
Ann Surg. 2022 Jan 1;275(1):54-66. doi: 10.1097/SLA.0000000000004757.
To assess metabolic dysfunctions and steatohepatosis after standard and local pancreatic resections for benign and premalignant neoplasms.
Duodenopancreatectomy, hemipancreatectomy, and parenchyma-sparing, limited pancreatic resections are currently in use for nonmalignant tumors.
Medline, Embase, and Cochrane libraries were searched for studies reporting measured data of metabolic functions following PD, pancreatic left resection (PLR), duodenum-sparing pancreatic head resection (DPPHR), pancreatic middle segment resection (PMSR), and tumor enucleation (TEN). Forty cohort studies comprising data of 2729 patients were eligible.
PD for benign tumor was associated in 46 of 327 patients (14.1%) with postoperative new onset of diabetes mellitus (pNODM) and in 109 of 243 patients (44.9%) with postoperative new onset of pancreatic exocrine insufficiency measured after a mean follow-up of 32 months. The meta-analysis displayed pNODM following PD in 32 of 204 patients (15.7%) and in 10 of 200 patients (5%) after DPPHR [P < 0.01; OR: 0.33; (95%-CI: 0.15-0.22)]. PEI was found in 77 of 174 patients following PD (44.3%) and in 7 of 104 patients (6.7%) following DPPHR (P < 0.01;OR: 0.15; 95%-CI: 0.07-0.32). pNODM following PLR was reported in 107 of 459 patients (23.3%) and following PMSR 23 of 412 patients (5.6%) (P < 0.01; OR: 0.20; 95%-CI: 0.12-0.32). Postoperative new onset of pancreatic exocrine insufficiency was found in 17% following PLR and in 8% following PMSR (P < 0.01). pNODM following PPPD and tumor enucleation was observed in 19.7% and 5.7% (P < 0.03) of patients, respectively. Following PD/PPPD, 145 of 608 patients (23.8%) developed a nonalcoholic fatty liver disease after a mean follow-up of 30.4 months. Steatohepatosis following DPPHR developed in 2 of 66 (3%) significantly lower than following PPPD (P < 0.01).
Standard pancreatic resections for benign tumor carry a considerable high risk for a new onset of diabetes, pancreatic exocrine insufficiency and following PD for steatohepatosis. Parenchyma-sparing, local resections are associated with low grade metabolic dysfunctions.
评估标准和局部胰腺切除术治疗良性和癌前肿瘤后的代谢功能障碍和脂肪性肝炎。
十二指肠胰腺切除术、胰体尾切除术和保留胰腺实质的有限胰腺切除术目前用于治疗非恶性肿瘤。
检索 Medline、Embase 和 Cochrane 数据库，以获取报告 PD、胰腺左叶切除术 (PLR)、保留胰头十二指肠切除术 (DPPHR)、胰腺中段切除术 (PMSR) 和肿瘤剜除术 (TEN) 后代谢功能测量数据的研究。40 项队列研究共纳入 2729 例患者的数据。
良性肿瘤的 PD 术后新发糖尿病（pNODM）发生率为 327 例中的 46 例（14.1%），术后新发胰腺外分泌功能不全的发生率为 243 例中的 109 例（44.9%），中位随访 32 个月。荟萃分析显示 PD 术后新发糖尿病的发生率为 204 例中的 32 例（15.7%），DPPHR 术后为 200 例中的 10 例（5%）（P < 0.01；OR：0.33；95%CI：0.15-0.22）。PD 术后发生胰腺外分泌功能不全的发生率为 174 例中的 77 例（44.3%），DPPHR 术后为 104 例中的 7 例（6.7%）（P < 0.01；OR：0.15；95%CI：0.07-0.32）。PLR 术后新发糖尿病的发生率为 459 例中的 107 例（23.3%），PMSR 术后为 412 例中的 23 例（5.6%）（P < 0.01；OR：0.20；95%CI：0.12-0.32）。PLR 术后和 PMSR 术后分别有 17%和 8%的患者发生新发胰腺外分泌功能不全（P < 0.01）。PPPD 和肿瘤剜除术后新发胰腺外分泌功能不全的发生率分别为 19.7%和 5.7%（P < 0.03）。PD/PPPD 后，608 例患者中有 145 例（23.8%）在平均 30.4 个月的随访中发生非酒精性脂肪性肝病。DPPHR 术后发生脂肪性肝炎的发生率为 2 例（3%），显著低于 PPPD 术后（P < 0.01）。
标准胰腺切除术治疗良性肿瘤存在新发糖尿病、胰腺外分泌功能不全和 PD 后脂肪性肝炎的较高风险。保留胰腺实质的局部切除术与较低程度的代谢功能障碍相关。
