Experience of local pancreatectomy in treatment of benign and low-grade malignant pancreatic tumors (clinical data analysis of 45 cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHOU Wei ,  WU Heshui

Department of Pancreatic Cancer, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430010, P. R. China;

Corresponding?author：

WU Heshui, Email: heshuiwu@163.com

Keywords：

benign pancreatic tumor; low-grade malignant pancreatic tumor; local pancreatectomy; pancreatic fistula; prognosis

DOI：

10.7507/1007-9424.202011060

Video：

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Objective To investigate the role of local pancreatectomy for benign and low-grade malignant pancreatic tumors.Method The clinical data of 45 patients with benign and low-grade malignant pancreatic tumors who underwent local pancreatectomy from January 2014 to June 2019 in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were analyzed.Results Forty-five patients underwent the local enucleation or resection with negative margin. The pathological results showed that there were 17 cases of solid pseudopapilloma, 5 cases of mucinous cystadenoma, 4 cases of serous cystadenoma, 10 cases of islet cell tumor, 5 cases of nonfunctional neuroendocrine tumor, 4 cases of congenital cyst. There were 6 cases of head of pancreas, 26 cases of body of pancreas, 8 cases of tail of pancreas, 5 cases of uncinate process. The tumor was 1.2 to 9.0 cm in diameter with an average of 3.2 cm. Among them, the diameter was more than 5.0 cm in 9 cases. The incidence of pancreatic fistula after operation was 57.8%, 65.4% was grade A fistula, 34.6% was grade B fistula, and no grade C fistula occurred. The incidence of abdominal infection was 13.3%, incidence of abdominal hemorrhage was 6.7%. There was no secondary diabetes mellitus and pancreatic endo- and exocrine dysfunction, and no death case.Conclusions Pancreatic enucleation for benign and low-grade malignant pancreatic tumors after strict preoperative evaluation can effectively preserve the pancreatic endocrine function of patients. Although the incidence of pancreatic fistula is high, it is mostly biochemical fistula, and the incidence of serious complications is low.

Citation： ZHOU Wei, WU Heshui. Experience of local pancreatectomy in treatment of benign and low-grade malignant pancreatic tumors (clinical data analysis of 45 cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(1): 8-11. doi: 10.7507/1007-9424.202011060 Copy

1.	Talamini MA, Moesinger R, Yeo CJ, et al. Cystadenomas of the pancreas: is enucleation an adequate operation? Ann Surg, 1998, 227(6): 896-903.
2.	原春輝, 葉辰, 陶明, 等. 胰頭部腫物局部切除后胰腸吻合治療胰頭部良性腫瘤. 中華外科雜志, 2016, 54(5): 376-379.
3.	朱堅剛, 喻強, 秦錫虎. 胰腺腫瘤局部切除術的臨床研究. 實用臨床醫藥雜志, 2017, 21(21): 209-211.
4.	曲輝, 王成鋒, 趙平, 等. 胰腺腫瘤局部切除 17 例臨床分析. 中華醫學雜志, 2008, 88(20): 1405-1407.
5.	Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery, 2017, 161(3): 584-591.
6.	Kiely JM, Nakeeb A, Komorowski RA, et al. Cystic pancreatic neoplasms: enucleate or resect? J Gastrointest Surg, 2003, 7(7): 890-897.
7.	牟一平, 陳其龍, 徐曉武, 等. 胰十二指腸切除術術后患者生活治療的隨訪研究. 中華外科雜志, 2007, 45(1): 17-20.
8.	Wolk S, Distler M, Kersting S, et al. Evaluation of central pancreatectomy and pancreatic enucleation as pancreatic resections–A comparison. Int J Surg, 2015, 22: 118-124.
9.	Falconi M, Mantovani W, Crippa S, et al. Pancreatic insufficiency after different resections for benign tumours. Br J Surg, 2008, 95(1): 85-91.
10.	Crippa S, Bassi C, Salvia R, et al. Enucleation of pancreatic neoplasms. Br J Surg, 2007, 94(10): 1254-1259.
11.	Brient C, Regenet N, Sulpice L, et al. Risk factors for postoperative pancreatic fistulization subsequent to enucleation. J Gastrointest Surg, 2012, 16(10): 1883-1887.
12.	Hackert T, Werner J, Büchler MW. Postoperative pancreatic fistula. Surgeon, 2011, 9(4): 211-217.
13.	Weilin M, Xu H, Yang L, et al. Propensity score-matched analysis of clinical outcome after enucleation versus regular pancreatectomy in patients with small non-functional pancreatic neuroendocrine tumors. Pancreatology, 2020, 20(2): 169-176.
14.	Hüttner FJ, Koessler-Ebs J, Hackert T, et al. Meta-analysis of surgical outcome after enucleation versus standard resection for pancreatic neoplasms. Br J Surg, 2015, 102(9): 1026-1036.
15.	Zhou Y, Zhao M, Wu L, et al. Short- and long-term outcomes after enucleation of pancreatic tumors: An evidence-based assessment. Pancreatology, 2016, 16(6): 1092-1098.
16.	中華醫學會外科學分會胰腺外科學組. 胰腺神經內分泌腫瘤治療指南 (2014). 中華普通外科學文獻 (電子版), 2015, 9(3): 175-178.
17.	中華醫學會外科學分會胰腺外科學組. 胰腺囊性疾病診治指南 (2015 版). 臨床肝膽病雜志, 2015, 31(9): 1375-1378.

1. Talamini MA, Moesinger R, Yeo CJ, et al. Cystadenomas of the pancreas: is enucleation an adequate operation? Ann Surg, 1998, 227(6): 896-903.
2. 原春輝, 葉辰, 陶明, 等. 胰頭部腫物局部切除后胰腸吻合治療胰頭部良性腫瘤. 中華外科雜志, 2016, 54(5): 376-379.
3. 朱堅剛, 喻強, 秦錫虎. 胰腺腫瘤局部切除術的臨床研究. 實用臨床醫藥雜志, 2017, 21(21): 209-211.
4. 曲輝, 王成鋒, 趙平, 等. 胰腺腫瘤局部切除 17 例臨床分析. 中華醫學雜志, 2008, 88(20): 1405-1407.
5. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery, 2017, 161(3): 584-591.
6. Kiely JM, Nakeeb A, Komorowski RA, et al. Cystic pancreatic neoplasms: enucleate or resect? J Gastrointest Surg, 2003, 7(7): 890-897.
7. 牟一平, 陳其龍, 徐曉武, 等. 胰十二指腸切除術術后患者生活治療的隨訪研究. 中華外科雜志, 2007, 45(1): 17-20.
8. Wolk S, Distler M, Kersting S, et al. Evaluation of central pancreatectomy and pancreatic enucleation as pancreatic resections–A comparison. Int J Surg, 2015, 22: 118-124.
9. Falconi M, Mantovani W, Crippa S, et al. Pancreatic insufficiency after different resections for benign tumours. Br J Surg, 2008, 95(1): 85-91.
10. Crippa S, Bassi C, Salvia R, et al. Enucleation of pancreatic neoplasms. Br J Surg, 2007, 94(10): 1254-1259.
11. Brient C, Regenet N, Sulpice L, et al. Risk factors for postoperative pancreatic fistulization subsequent to enucleation. J Gastrointest Surg, 2012, 16(10): 1883-1887.
12. Hackert T, Werner J, Büchler MW. Postoperative pancreatic fistula. Surgeon, 2011, 9(4): 211-217.
13. Weilin M, Xu H, Yang L, et al. Propensity score-matched analysis of clinical outcome after enucleation versus regular pancreatectomy in patients with small non-functional pancreatic neuroendocrine tumors. Pancreatology, 2020, 20(2): 169-176.
14. Hüttner FJ, Koessler-Ebs J, Hackert T, et al. Meta-analysis of surgical outcome after enucleation versus standard resection for pancreatic neoplasms. Br J Surg, 2015, 102(9): 1026-1036.
15. Zhou Y, Zhao M, Wu L, et al. Short- and long-term outcomes after enucleation of pancreatic tumors: An evidence-based assessment. Pancreatology, 2016, 16(6): 1092-1098.
16. 中華醫學會外科學分會胰腺外科學組. 胰腺神經內分泌腫瘤治療指南 (2014). 中華普通外科學文獻 (電子版), 2015, 9(3): 175-178.
17. 中華醫學會外科學分會胰腺外科學組. 胰腺囊性疾病診治指南 (2015 版). 臨床肝膽病雜志, 2015, 31(9): 1375-1378.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience of local pancreatectomy in treatment of benign and low-grade malignant pancreatic tumors (clinical data analysis of 45 cases)

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