Clinical Application Of Limited Pancreatic Resection In Benign And Borderline Tumors

Background: There are various types of pancreatic diseases,and most of which require surgical intervention are tumorigenic lesions of the pancreas.The traditional surgical procedures for removing pancreatic tumors include pancreaticoduodenectomy,distal pancreatectomy and total pancreaticoduodenectomy.These surgical procedures destroy the integrity of the anatomical structure of the upper gastrointestinal tract and lose a large amount of normal pancreatic tissue,resulting in inadequate endocrine and exocrine function of the pancreas,which reduces the quality of life of patients after surgery.However,for patients with benign or borderline pancreatic tumors,their long-term survival is usually possible after surgical treatment,and therefore they have a higher demand for quality of life after surgery.In this view,in order to preserve as much normal pancreatic parenchyma as possible and maintain the intact anatomy of the upper gastrointestinal tract,some scholars have proposed the idea that limited pancreatic resection can be used to treat benign and junctional pancreatic tumors.Depending on the location and size of pancreatic tumor lesions,limited pancreatic resection can be specified into the following five surgical procedures: enucleation of pancreatic tumor,distal pancreatectomy with pancreatic body approach,middle pancreatectomy,middle-preserving pancreatectomy,and duodenum-preserving pancreatic head resection.Objective: Limited pancreatic resection is a procedure that takes multiple approaches to preserve as much normal pancreatic tissue as possible,thus effectively maintaining the endocrine and exocrine functions of the pancreas.This type of surgery protects the long-term metabolic function of the patient and also determines whether to preserve the function of the adjacent organs of the pancreas based on the intraoperative situation（such as the location and size of the lesion and the results of intraoperative rapid frozen section）.Limited pancreatic resection is more focused on preserving the pancreatic parenchyma and is the preferred surgical approach for benign and borderline tumors of the pancreas.The purpose of this work is to investigate the safety,feasibility,and effectiveness of limited pancreatic resection for the treatment of benign and junctional tumors.Methods: The clinical case data of 158 patients who underwent limited pancreatic resection in our hospital from Nov.2009 to Nov.2021 were analyzed retrospectively.All patients had intraoperative frozen section findings of benign or borderline tumors of the pancreas.The case data of patients were collected through the medical record system and follow-up survey,including general information such as gender and age,intraoperative information such as surgical method,operation time,intraoperative bleeding and intraoperative blood transfusion,and postoperative information such as pathological findings,postoperative hospital stay,complications,endo-and exopancreatic function and quality of life.SPSS 21.0 software was applied for data analysis.Results: Enucleation of pancreatic tumors was performed in 37 patients.The average operative time was 163.19±68.58 min.The intraoperative bleeding was 113.24±128.54 ml.3 cases had intraoperative blood transfusion.The average postoperative hospital stay was 10.92±4.69 days.Postoperatively,there were 12 cases of biochemical leak,2cases of grade B pancreatic leak,1 case of abdominal infection,1 case of impaired fasting glucose,2 cases of new onset diabetes mellitus,and no bleeding or delayed gastric emptying occurred.90 patients underwent distal pancreatectomy with the body of the pancreas approach.The average operative time was 217.68±74.16 min.The intraoperative bleeding was 241.44±184.48 ml.17 cases had intraoperative blood transfusion.The average postoperative hospital stay was 11.92±4.93 days.Postoperatively,there were 48 cases of biochemical leak,7 cases of grade B pancreatic leak,1 case of severe bleeding,2 cases of mild bleeding,7 cases of abdominal infection,1 case of mild delayed gastric emptying,10 cases of impaired fasting glucose,2 cases of new onset diabetes mellitus,and 1 case of pancreatic exocrine insufficiency.28 patients underwent middle pancreatectomy.The average operative time was 347.75±87.43 min.The intraoperative bleeding was 214.29±164.91 ml.4 cases had intraoperative blood transfusion.The average postoperative hospital stay was 19.29±9.08 days.There were 6cases of biochemical leak,6 cases of grade B pancreatic leak,1 case of severe bleeding,9 cases of abdominal infection,2 cases of impaired fasting glucose,1 case of new onset diabetes mellitus,and no delayed gastric emptying occurred.One patient underwent middle-preserving pancreatectomy.The operative time was 535 min.And the intraoperative bleeding was 800 ml.This patient had blood transfusion during the operation.The postoperative hospital stay was 43 days.This patient developed postoperative grade B pancreatic leak,abdominal infection,moderate delayed gastric emptying,and pancreatic exocrine insufficiency.Two patients underwent duodenum-preserving pancreatic head resection.Their operative times were 260 min and 390 min,and intraoperative bleeding was 150 ml and 200 ml,respectively.1 patient had intraoperative blood transfusion.They were hospitalized for 25 and 16 days after surgery,respectively.1 patient had a postoperative grade B pancreatic leak,and no postoperative bleeding,abdominal infection or delayed gastric emptying occurred.Conclusion: Limited pancreatic resection includes pancreatic tumor enucleation,distal pancreatic resection with a pancreatic body approach,middle pancreatectomy,middle-preserving pancreatectomy and duodenum-preserving pancreatic head resection.These procedures can replace conventional pancreatic surgery within their respective indications and achieve the desired goal of complete resection of the lesion.They are also within acceptable limits in terms of postoperative complications such as postoperative bleeding,pancreatic leakage,infection and delayed gastric emptying,and play a positive role in preserving the endocrine and exocrine functions of the pancreas and improving the long-term quality of life of patients after surgery.Therefore,limited pancreatic resection for the treatment of benign and junctional tumors is safe,feasible,and effective in preserving more of the internal and external secretory function of the pancreas.