Li Yu-Qiong, Pan Shu-Bo, Yan Shu-Shu, Jin Zhen-Dong, Huang Hao-Jie, Sun Li-Qi
Department of Gastroenterology, Changhai Hospital, Shanghai 200433, China.
Department of Anesthesiology, Changhai Hospital, Shanghai 200433, China.
World J Gastrointest Surg. 2022 Feb 27;14(2):174-184. doi: 10.4240/wjgs.v14.i2.174.
Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare neoplasm that mainly affects young women.
To evaluate the impact of parenchyma-preserving surgical methods (PPMs, including enucleation and central pancreatectomy) in the treatment of SPN patients.
From 2013 to 2019, patients who underwent pancreatectomy for SPNs were retrospectively reviewed. The baseline characteristics, intraoperative index, pathological outcomes, short-term complications and long-term follow-up data were compared between the PPM group and the conventional method (CM) group.
In total, 166 patients were included in this study. Of them, 33 patients (19.9%) underwent PPM. Most of the tumors (104/166, 62.7%) were found accidentally. Comparing the parameters between groups, the hospital stay d (12.35 13.5 d, = 0.49), total expense (44213 54084 yuan, = 0.21), operation duration (135 120 min, = 0.71), and intraoperative bleeding volume (200 100 mL, = 0.49) did not differ between groups. Regarding pathological outcomes, tumor size (45 32 mm, = 0.07), Ki67 index ( = 0.53), peripheral tissue invasion (11.3% 9.1%, = 0.43) and positive margin status (7.5% 6%, = 0.28) also did not differ between groups. Moreover, PPM did not increase the risk of severe postoperative pancreatic fistula (3.8% 3.0%, = 0.85) or tumor recurrence (3.0% 6.0%, = 0.39). However, the number of patients who had exocrine insufficiency during follow-up was significantly lower in the PPM group (21.8% 3%, = 0.024). CM was identified as an independent risk factor for pancreatic exocrine insufficiency (odds ratio = 8.195, 95% confident interval: 1.067-62.93).
PPM for SPN appears to be feasible and safe for preserving the exocrine function of the pancreas.
胰腺实性假乳头状瘤（SPN）是一种罕见肿瘤，主要影响年轻女性。
评估保留实质的手术方法（PPMs，包括摘除术和胰腺中段切除术）对SPN患者治疗的影响。
回顾性分析2013年至2019年因SPN接受胰腺切除术的患者。比较PPM组和传统方法（CM）组的基线特征、术中指标、病理结果、短期并发症和长期随访数据。
本研究共纳入166例患者。其中，33例（19.9%）接受了PPM。大多数肿瘤（104/166，62.7%）是偶然发现的。比较两组参数，住院天数（12.35对13.5天，P = 0.49）、总费用（44213对54084元，P = 0.21）、手术时长（135对120分钟，P = 0.71）和术中出血量（200对100毫升，P = 0.49）在两组间无差异。关于病理结果，肿瘤大小（45对32毫米，P = 0.07）、Ki67指数（P = 0.53）、外周组织侵犯（11.3%对9.1%，P = 0.43）和切缘阳性状态（7.5%对6%，P = 0.28）在两组间也无差异。此外，PPM未增加术后严重胰瘘风险（3.8%对3.0%，P = 0.85）或肿瘤复发风险（3.0%对6.0%，P = 0.39）。然而，PPM组随访期间出现外分泌功能不全的患者数量显著更低（21.8%对3%，P = 0.024）。CM被确定为胰腺外分泌功能不全的独立危险因素（比值比 = 8.195，95%置信区间：1.067 - 62.93）。
SPN的PPM对于保留胰腺外分泌功能似乎是可行且安全的。
