• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.1
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• pp.87-94
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• 2023

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.

• Journal of Digestive Cancer Research
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• v.4 no.2
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• pp.77-82
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• 2016

The 26^th World Congress of the International Association of Surgeons, Gastroenterologists and Oncologists (IASGO) was held in Seoul, Korea from September 8 to 10, 2016. In this congress, I gave a State-of-the-Art Lecture II entitled "Mesenteric Approach in Pancreatoduodenectomy." The ideal surgery for pancreatic head cancer is isolated pancreatoduodenectomy, which involves en bloc resection using a non-touch isolation technique. My team has been developing isolated pancreatoduodenectomy for pancreatic cancer since 1981, when we developed an antithrombogenic bypass catheter for the portal vein. In this operation, the first and most important step is the use of a mesenteric approach instead of Kocher's maneuver. The mesenteric approach allows dissection from the non-cancer infiltrating side and determination of cancer-free margins and resectability, followed by systematic lymphadenectomy around the superior mesenteric artery. This approach enables early ligation of the inferior pancreatoduodenal artery and total mesopancreas excision. It is the ideal surgery for pancreatic head cancer from both oncological and surgical viewpoints. The precise surgical techniques of the mesenteric approach are herein described.