Yamane Masahiro, Ishikawa Yoshiya, Yamashita Hironari, Morimoto Koichiro, Asano Daisuke, Sugawara Toshitaka, Watanabe Shuichi, Ueda Hiroki, Akahoshi Keiichi, Ono Hiroaki, Tanaka Shinji, Tanabe Minoru
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Surg Today. 2024 Dec 10. doi: 10.1007/s00595-024-02973-0.
Middle-segment preserving pancreatectomy (MSPP) serves as an alternative to total pancreatectomy (TP) for preserving the pancreatic body in multifocal pancreatic neoplasms. Despite the potential benefits of TP, the detailed short- and long-term prognoses remain unclear. We evaluated the feasibility of MSPP by comparing the perioperative outcomes and postoperative endocrine and exocrine functions with those of TP.
The study included 10 TP and 7 MSPP patients. Patients with pancreatic ductal adenocarcinoma and invasive intraductal papillary mucinous carcinoma were excluded.
MSPP was associated with a high incidence (57.1%) of postoperative pancreatic fistula (POPF); however, there were no cases of post-pancreatectomy hemorrhage or postoperative mortality in any group. The postoperative hospital stay and readmission rates were comparable between the groups. At 1 year postoperatively, MSPP reduced the risk of new-onset insulin-dependent diabetes mellitus, maintained good glycemic control with minimal hypoglycemic events, and preserved skeletal muscle, subcutaneous fat, and visceral fat. One patient in the MSPP group with a neuroendocrine tumor had postoperative recurrence in the para-aortic lymph node.
Despite the high POPF rate and oncologic limitations, MSPP showed superior long-term outcomes in glycemic control and preservation of body composition. MSPP may be an acceptable treatment option for selected patients.
保留中段胰腺切除术（MSPP）可作为全胰腺切除术（TP）的替代方案，用于在多灶性胰腺肿瘤中保留胰体。尽管TP有潜在益处，但其详细的短期和长期预后仍不明确。我们通过比较MSPP与TP的围手术期结果以及术后内分泌和外分泌功能，评估了MSPP的可行性。
该研究纳入了10例接受TP的患者和7例接受MSPP的患者。排除了胰腺导管腺癌和浸润性导管内乳头状黏液癌患者。
MSPP术后胰瘘（POPF）发生率较高（57.1%）；然而，任何组均未发生胰切除术后出血或术后死亡病例。两组术后住院时间和再入院率相当。术后1年时，MSPP降低了新发胰岛素依赖型糖尿病的风险，以最少的低血糖事件维持了良好的血糖控制，并保留了骨骼肌、皮下脂肪和内脏脂肪。MSPP组1例患有神经内分泌肿瘤的患者在主动脉旁淋巴结出现术后复发。
尽管POPF发生率高且存在肿瘤学方面的局限性，但MSPP在血糖控制和身体成分保留方面显示出更好的长期结果。对于选定的患者，MSPP可能是一种可接受的治疗选择。
