General Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy.
General Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy.
Surg Oncol. 2021 Sep;38:101582. doi: 10.1016/j.suronc.2021.101582. Epub 2021 Apr 16.
The extent of pancreatic resection for intraductal papillary mucinous neoplasms (IPMNs) remains an unresolved issue. The study aims at analyzing the prognostic impact of conservative surgery (CS) i.e. of pancreatoduodenectomy or distal pancreatectomy, versus total pancreatectomy (TP), for pancreatic IPMNs.
We retrospectively analyzed and compared data of patients who had undergone pancreatic resection for IPMNs at our center between November 2007 and April 2019. Patients were divided into two main groups based on the extent of surgery: TP-group and CS-group. Subsequently, the perioperative and the long-term outcomes were compared. Moreover, a sub-group analysis of patients with IPMN alone and patients with malignant IPMN, based on preoperative indications to surgery and post-operative histopathological findings, was also performed.
Fifty-three patients were included in the TP-group and 73 in the CS-group. In 50 (39.7%) cases the frozen section changed the pre-operative surgical planning, with an extension of the pancreatic resection, in 43 (34.1%) cases up to a total pancreatectomy. Twenty-six patients (20.6%) with low-grade dysplasia at the frozen section underwent CS, while twenty (15.8%) underwent TP. Comparing these two sub-groups no differences were found in surgical IPMN recurrence, nor progression. The rate of overall postoperative complications was 56.6% in the TP-group and 57.5% in the CS-group (p = 0.940). Fifteen patients (20.5%) developed diabetes in the CS-group. None of the patients treated with CS developed a surgical IPMN recurrence or progression during the follow-up period. Comparing OS and DFS of the two groups, we did not find any statistically significant difference (p = 0.619 and 0.315).
A timely CS can be considered an appropriate and valid strategy in the surgical treatment of the majority of pancreatic IPMNs, as it can avoid the serious long-term metabolic consequences of TP in patients with a long-life expectancy. On the contrary, TP remains mandatory in case of PDAC or high-risk features involving the entire gland.
对于胰腺导管内乳头状黏液性肿瘤（IPMNs），胰腺切除术的范围仍然是一个悬而未决的问题。本研究旨在分析对于胰腺 IPMNs，采用保留性手术（CS），即胰十二指肠切除术或胰远端切除术，与全胰切除术（TP）相比，对预后的影响。
我们回顾性分析了 2007 年 11 月至 2019 年 4 月期间在我们中心接受胰腺 IPMNs 切除术的患者数据，并根据手术范围将患者分为两组：TP 组和 CS 组。随后比较两组围手术期和长期结果。此外，还根据术前手术指征和术后组织病理学检查，对 IPMN 单一病变和恶性 IPMN 患者进行了亚组分析。
TP 组纳入 53 例患者，CS 组纳入 73 例患者。50 例（39.7%）患者的冰冻切片改变了术前手术计划，扩大了胰腺切除术范围，其中 43 例（34.1%）患者最终行全胰切除术。26 例（20.6%）冰冻切片显示低级别异型增生的患者行 CS，而 20 例（15.8%）患者行 TP。比较这两个亚组，在手术性 IPMN 复发或进展方面无差异。TP 组的总体术后并发症发生率为 56.6%，CS 组为 57.5%（p=0.940）。CS 组中有 15 例（20.5%）患者发生糖尿病。在随访期间，行 CS 的患者均未发生手术性 IPMN 复发或进展。比较两组的 OS 和 DFS，无统计学差异（p=0.619 和 0.315）。
及时行 CS 可被视为大多数胰腺 IPMNs 外科治疗的合适且有效的策略，因为它可以避免 TP 在预期寿命较长的患者中带来的严重长期代谢后果。相反，在存在 PDAC 或累及整个腺体的高危特征的情况下，仍需要行 TP。
