Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Langenbecks Arch Surg. 2024 Mar 11;409(1):91. doi: 10.1007/s00423-024-03285-0.
Central pancreatectomy (CP) offers parenchymal preservation compared to conventional distal pancreato-splenectomy for pancreatic neck and body tumours. However, it is associated with more morbidity. This study is aimed at evaluating the peri-operative and long-term functional outcomes, comparing central and distal pancreatectomies (DPs).
Retrospective analysis of patients undergoing pancreatic resections for low-grade malignant or benign tumours in pancreatic neck and body was performed (from January 2007 to December 2022). Preoperative imaging was reviewed for all cases, and only patients with uninvolved pancreatic tail, whereby a CP was feasible, were included. Peri-operative outcomes and long-term functional outcomes were compared between CP and DP.
One hundred twenty-two (5.2%) patients, amongst the total of 2304 pancreatic resections, underwent central or distal pancreatectomy for low-grade malignant or benign tumours. CP was feasible in 55 cases, of which 23 (42%) actually underwent CP and the remaining 32 (58%) underwent DP. CP group had a significantly longer operative time [370 min (IQR 300-480) versus 300 min (IQR 240-360); p = 0.002]; however, the major morbidity (43.5% versus 37.5%; p = 0.655) and median hospital stay (10 versus 11 days; p = 0.312) were comparable. The long-term endocrine functional outcome was favourable for the CP group [endocrine insufficiency rate was 13.6% in central versus 42.8% in distal (p = 0.046)].
Central pancreatectomy offers better long-term endocrine function without any increased morbidity in low malignant potential or benign pancreatic tumours of neck and body region.
与传统的胰远端脾切除术相比，胰体尾切除术（CP）可保留实质，适用于胰腺颈部和体部的肿瘤。然而，它与更高的发病率相关。本研究旨在评估中央和胰远端切除术（DP）的围手术期和长期功能结果。
对 2007 年 1 月至 2022 年 12 月期间行胰腺颈部和体部低级别恶性或良性肿瘤胰腺切除术的患者进行回顾性分析。对所有病例进行术前影像学检查，仅纳入未累及胰腺尾部且可行 CP 的患者。比较 CP 和 DP 之间的围手术期和长期功能结果。
在 2304 例胰腺切除术中，有 122 例（5.2%）患者因低级别恶性或良性肿瘤行中央或胰远端切除术。55 例可行 CP，其中 23 例（42%）实际行 CP，其余 32 例（58%）行 DP。CP 组的手术时间明显较长[370 分钟（IQR 300-480）比 300 分钟（IQR 240-360）；p=0.002]；然而，主要发病率（43.5%比 37.5%；p=0.655）和中位住院时间（10 天比 11 天；p=0.312）相似。CP 组的长期内分泌功能结果良好[中央组内分泌不全发生率为 13.6%，而远端组为 42.8%（p=0.046）]。
在低恶性潜能或颈部和体部良性胰腺肿瘤中，CP 可提供更好的长期内分泌功能，而不会增加发病率。
