Clinical Research Of Surgical Procedure And Postoperative Outcome Of Pancreatic Body And Tail Tumor Based On Large Data Analysis

BackgroundPancreatic tumor is divided into the following eight categories by WHO classification:serous cystic neoplasms,mucinous cystic neoplasms,intraductal papillary mucinous neoplasms,neuroendocrine tumor,solid pseudopapillary tumor,ductal adenocarcinoma,acinar cell carcinoma and metastatic cancer.According to their biological characteristics,the first five categories of tumors are usually regarded as benign and low malignant tumors;the latter three are classified as typical malignant tumors.With the enhancement of people’s health consciousness and the progress and popularization of imaging technology,the detection rate of pancreatic neoplasms increasingly rises,espacially for pancreatic cystic tumor.Furthermore,the tumors located in the tail and body of the pancreas account for about 50%of all pancreatic tumors,for which distal pancreatic resection is always required.Objectives1.To establish the electronic database of pancreatic body and tail resection of Peking Union Medical College Hospital and realize unified management and follow-up.2.To study the advantages and disadvantages of minimally invasive distal pancreatectomy compared with conventional open surgery.3.To study the factors influencing the preversation of’ spleen in pancreatic body and tail resection and its relationship with postoperative short-term complications.4.To study the long-term complications after distal pancreatectomy and their influencing factors.5.To study the surgical approach of ductal adenocarcinoma in pancreatic body and tail and its correlation with prognosis.MethodsBy establishing an electronic database of distal pancreatectomy of Peking Union Medical College Hospital,the above five issues were researched,based on the analysis of large data.PSM(Propensity Score Matchin)and ITT(Intention-To-Treat)analysis methods were used to minimize the influence of selection bias and intraoperative conversion on the results.Univariate and multivariate analysis were used to screen risk factors for long-term complications after distal pancreatectomy;Logistics regression model was used to fit the Risk Scoring System for the development of diabetes mellitus after distal pancreatectomy.Cox reggression model was employed to analysis the risk factors for prognosis of ductal adenocarcinoma in the left-side of pancreas.Results1.The electronic database of pancreatic body and tail resection of Peking Union Medical College Hospital was established successfully and the unified management and follow-up of these cases was realized;distal pancreatectomy was the second most commonly pancreatic procedure following pancreaticoduodenectomy;benign and low-grade malignant lesion accounts for 65%distal pancreatectomy cases,while ductal adenocarcinoma and other malignant tumors accounted for 35%;the most common five pathological types of distal pancreatectomy were ductal adenocarcinoma,neuroendocrine tumors,mucinous cystic neoplasms,serous cystic neoplasms and solid pseudopapillary tumors.2.Compared with open surgery,minimally invasive distal pancreatectomy was associated with less blood loss,lower intraoperative blood transfusion rate,shorter period to restore eating and shorter postoperative hospital stay;high BMI and large tumor were independent risk factors for conversion from minimally invasive surgery to open surgery.3.The operation time,blood loss and the blood transfusion rate were significantly less in SPDP(Spleen-Preserving Distal Pancreatectomy)group than that in DPS(Distal Pancreatectomy with Splenectomy)group;but there was no significant difference in postoperative complications between the two groups.The tumor diameter of 3 CM can be used as an independent predictor of splenic vessels preservation.4.Age,BMI,surgical blood loss,spleen preservation,tumor location and length of resected pancreas(including tumor)were independent predictors for new-onset diabetes mellitus after distal pancreatectomy.Spleen preservation is a protective factor for new-onset diabetes mellitus after distal pancreatectomy.Risk Scoring System can predict development of diabetes mellitus after distal pancreatectomy satisfactorily.5.The RAMPS(Radical Antegrade Modular Pancreatosplenectomy)could increase the number of lymph node dissection,reduce the local recurrence rate,and significantly prolong the overall survival of the patient with ductal adenocarcinoma in the left-side pancreas.Compared with conventional open surgery,minimally invasive surgery could accelerate the rehabilitation of patients,but did not reduce the safety of tumor resection for ductal adenocarcinoma of the left-side pancreas.ConclusionThe establishment of electronic databases for distal pancreatectomy cases can provide a unified platform for clinical research;minimally invasive surgery can promote the recovery of patients after pancreatic body and tail resection;amomg patients with benign and low-grade malignant tumor in distal pancreas,the preservation of spleen can reduce operative would,and significantly reduce the incidence of postoperative new-onset diabetes mellitus;radical anterograde module pancreatosplenectomy is safe and feasible,can significantly reduce the local recurrence rate and extend disease-free and overall survival of patients with ductal adenocarcinoma of the left-side pancreas.