Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지
DOI QR코드

DOI QR Code

Is central pancreatectomy an effective alternative to distal pancreatectomy for low-grade pancreatic neck and body tumors: A 20-year single-center propensity score-matched case-control study

  • Ashish Kumar Bansal (Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences) ;
  • Bheerappa Nagari (Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences) ;
  • Phani Kumar Nekarakanti (Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences) ;
  • Amith Kumar Pakkala (Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences) ;
  • Venu Madhav Thumma (Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences) ;
  • Surya Ramachandra Varma Gunturi (Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences) ;
  • Madhur Pardasani (Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences)
  • Received : 2022.06.10
  • Accepted : 2022.08.18
  • Published : 2023.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Backgrounds/Aims: Central pancreatectomy (CP) is associated with a higher rate of postoperative pancreatic fistula (POPF), and it is less preferred over distal pancreatectomy (DP). We compared the short- and long-term outcomes between CP and DP for low-grade pancreatic neck and body tumors. Methods: This was a propensity score-matched case-control study of patients who underwent either CP or DP for low-grade pancreatic neck and body tumors from 2003 to 2020 in a tertiary care unit in southern India. Patients with a tumor >10 cm or a distal residual stump length of <4 cm were excluded. Demographics, clinical profile, intraoperative and postoperative parameters, and the long-term postoperative outcomes for exocrine and endocrine insufficiency, weight gain, and the 36-Item Short Form Survey (SF-36) quality of life questionnaire were compared. Results: Eighty-eight patients (CP: n=37 [cases], DP: n=51 [control]) were included in the unmatched group after excluding 21 patients (meeting exclusion criteria). After matching, both groups had 37 patients. The clinical and demographic profiles were comparable between the two groups. Blood loss and POPF rates were significantly higher in the CP group. However, Clavien-Dindo grades of complications were similar between the two groups (p = 0.27). At a median follow-up of 38 months (range = 187 months), exocrine sufficiency was similar between the two groups. Endocrine sufficiency, weight gain, SF-36 pain control score, and general health score were significantly better in the CP group. Conclusions: Despite equivalent clinically significant morbidities, long-term outcomes are better after CP compared to DP in low-grade pancreatic body tumors.

Keywords

Acknowledgement

We thank Prof. Vinay Kumar Kapoor for peer reviewing this manuscript and insightful discussions and valuable suggestions.

References

  1. Lee DH, Jang JY. ASO author reflections: central pancreatectomy versus distal pancreatectomy and pancreaticoduodenectomy for benign or low-grade malignant neoplasms: a propensity score-matched study with long-term functional outcomes and pancreas volumetry. Ann Surg Oncol 2020;27:1225-1226.
  2. Iacono C, Verlato G, Ruzzenente A, Campagnaro T, Bacchelli C, Valdegamberi A, et al. Systematic review of central pancreatectomy and meta-analysis of central versus distal pancreatectomy. Br J Surg 2013;100:873-885.
  3. Mahseeri M, Alqaiseieh A, Alkhader D, Halbony H, Albreazat M, Abualhaj S. Central pancreatectomy for solid pseudopapillary neoplasm: a pancreatic-preserving procedure. Int J Surg Case Rep 2021;79:91-93.
  4. Lv A, Qian HG, Qiu H, Wu JH, Hao CY. Is central pancreatectomy truly recommendable? A 9-year single-center experience. Dig Surg 2018;35:532-538.
  5. Girish S, Kapil N, Kannan N. Central pancreatectomy: significance of vascularity on anastomotic integrity and a note on reconstructive technique. Cureus 2021;13:e18617.
  6. Lee DH, Han Y, Byun Y, Kim H, Kwon W, Jang JY. Central pancreatectomy versus distal pancreatectomy and pancreaticoduodenectomy for benign and low-grade malignant neoplasms: a retrospective and propensity score-matched study with long-term functional outcomes and pancreas volumetry. Ann Surg Oncol 2020;27:1215-1224.
  7. Nag HH, Nekarakanti PK, Arvinda PS, Sharma A. Laparoscopic versus open surgical management of patients with chronic pancreatitis: a matched case-control study. J Minim Access Surg 2022;18:191-196.
  8. Johnson MA, Rajendran S, Balachandar TG, Kannan DG, Jeswanth S, Ravichandran P, et al. Central pancreatectomy for benign pancreatic pathology/trauma: is it a reasonable pancreas-preserving conservative surgical strategy alternative to standard major pancreatic resection? ANZ J Surg 2006;76:987-995.
  9. Brown KM, Shoup M, Abodeely A, Hodul P, Brems JJ, Aranha GV. Central pancreatectomy for benign pancreatic lesions. HPB (Oxford) 2006;8:142-147.
  10. Gao H, Liu T, Wang G, Gao Y, Yin L, Peng Y, et al. Central pancreatectomy for early-stage pancreatic ductal adenocarcinoma: a single-center case-control study. Langenbecks Arch Surg 2019;404:175-182.
  11. Dokmak S, Aussilhou B, Paci M, Fteriche FS, Cros J, Maire F, et al. Extended laparoscopic central pancreatectomy with clamping of the mesentericoportal vein and resection of the splenic vessels for a large solid pseudopapillary tumor. Ann Surg Oncol 2019;26:3709-3710.
  12. Senthilnathan P, Gul SI, Gurumurthy SS, Palanivelu PR, Parthasarathi R, Palanisamy NV, et al. Laparoscopic central pancreatectomy: our technique and long-term results in 14 patients. J Minim Access Surg 2015;11:167-171.
  13. Kang P, Wang Z, Leng K, Zhong X, Wang H, Wan M, et al. Binding pancreaticogastrostomy anastomosis in central pancreatectomy: a single center experience. Medicine (Baltimore) 2017;96:e8354.
  14. Wayne M, Neragi-Miandoab S, Kasmin F, Brown W, Pahuja A, Cooperman AM. Central pancreatectomy without anastomosis. World J Surg Oncol 2009;7:67.
  15. Lyu Y, Li T, Cheng Y, Wang B, Chen L, Zhao S. Pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: an up-to-date meta-analysis of RCTs applying the ISGPS (2016) criteria. Surg Laparosc Endosc Percutan Tech 2018;28:139-146.
  16. Sauvanet A, Partensky C, Sastre B, Gigot JF, Fagniez PL, Tuech JJ, et al. Medial pancreatectomy: a multi-institutional retrospective study of 53 patients by the French Pancreas Club. Surgery 2002;132:836-843.
  17. Wang ZZ, Zhao GD, Zhao ZM, Hu MG, Tan XL, Zhang X, et al. A comparative study of end-to-end pancreatic anastomosis versus pancreaticojejunostomy after robotic central pancreatectomy. Updates Surg 2021;73:967-975.
  18. Regmi P, Yang Q, Hu HJ, Liu F, Karn HR, Ma WJ, et al. Overall postoperative morbidity and pancreatic fistula are relatively higher after central pancreatectomy than distal pancreatic resection: a systematic review and meta-analysis. Biomed Res Int 2020;2020:7038907.
  19. Dragomir MP, Sabo AA, Petrescu GED, Li Y, Dumitrascu T. Central pancreatectomy: a comprehensive, up-to-date meta-analysis. Langenbecks Arch Surg 2019;404:945-958.
  20. Zhang RC, Zhang B, Mou YP, Xu XW, Zhou YC, Huang CJ, et al. Comparison of clinical outcomes and quality of life between laparoscopic and open central pancreatectomy with pancreaticojejunostomy. Surg Endosc 2017;31:4756-4763.