Jung Dawn, Bari Hassaan, Hwang Ho Kyoung, Lee Woo Jung, Kang Chang Moo
Division of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, South Korea; Pancreatobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea.
Aga Khan University Hospital, Karachi, Pakistan.
Asian J Surg. 2023 Feb;46(2):824-828. doi: 10.1016/j.asjsur.2022.08.084. Epub 2022 Sep 8.
Central pancreatectomy(CP) is more complex surgery and higher complication rate than distal pancreatectomy(DP). However, with the development of minimally invasive surgery, CP has become a safer surgery technique. In this study, we compare minimally invasive CP(MI-CP) and Minimally invasive spleen-preserving subtotal DP(MI-SpSTDP) to figure out the short-term and long-term outcomes of MI-CP.
From March 2007 to June 2020, 36 cases of MI-SpSTDP and 23 cases of MI-CP were performed for benign and borderline malignant pancreatic tumors in Severance hospital. The occurrence of postoperative pancreatic fistula(POPF) and Clavian-Dindo classification grade 3 or more in the two group was investigated, and the Controlling nutritional status scores(CONUT score) before and 1-year after surgery were compared to determine the long-term outcomes of exocrine function.
There was no difference in postoperative complications including POPF between the two groups(17.4% vs 5.1%, p = 0.294). And there were no statistical differences in either the MI-CP group (0.74 ± 0.75 vs. 0.78 ± 0.99, p = 0.803) or the MI-SpSTDP group (0.86 ± 0.83 to 0.61 ± 0.59, p = 0.071).
MI-CP had longer operation time and hospital stay and is safe and effective in preserving endocrine and exocrine functions in treatment of benign or borderline tumors located at the neck or proximal body of the pancreas.
与胰体尾切除术（DP）相比，全胰切除术（CP）是一种更复杂的手术，并发症发生率更高。然而，随着微创手术的发展，CP已成为一种更安全的手术技术。在本研究中，我们比较了微创全胰切除术（MI-CP）和微创保留脾脏的胰体尾次全切除术（MI-SpSTDP），以明确MI-CP的短期和长期疗效。
2007年3月至2020年6月，Severance医院对36例MI-SpSTDP和23例MI-CP患者进行了良性和交界性恶性胰腺肿瘤手术。调查两组术后胰瘘（POPF）的发生情况以及Clavian-Dindo分类3级及以上情况，并比较术前和术后1年的控制营养状态评分（CONUT评分），以确定外分泌功能的长期疗效。
两组术后包括POPF在内的并发症无差异（17.4%对5.1%，p = 0.294）。MI-CP组（0.74±0.75对0.78±0.99，p = 0.803）和MI-SpSTDP组（0.86±0.83对0.61±0.59，p = 0.071）均无统计学差异。
MI-CP手术时间和住院时间更长，在治疗位于胰腺颈部或体部近端的良性或交界性肿瘤时，在保留内分泌和外分泌功能方面安全有效。
