Conservative Resection For Benign And Borderline Tumors Of The Proximal Pancreas

Aim of the researchPancreatic benign or borderline tumors include cystadenoma, ascomal pseudopapillomatosis, insulinoma, intraductal papilloma, et al. patients with tumor mentioned above could be cured if tumors could be resected totally. Conservative resection including partial pancreatectomy, local pancreatic resection and pancreatic tumor enucleation has been used in operations of benign and low-grade malignant pancreatic tumor. It is considered to be dangerous to do conservative resection for the proximal pancreatic tumor, especially for tumors near to main pancreatic duct and bile duct. In this research, we reviewed the patients records to have conservative resection for the proximal tumor in our hospital, and show the evidences about the safety and usefulness of conservative resection of pancreatic benign or borderline tumors.Materials and methodWe reviewed114patients diagnosed as "pancreatic benign tumor" and having operation from2000.01.01to2013.01.01in the second affiliated hospital to medical college of Zhejiang university.57pancreatic tumors of them located in the proximal pancreas, including head, uncinate process, neck and proximal body of pancreas, of which,33cases received conservative resection,24cases received duodenopancreatectomy.33cases received conservative resection in the proximal pancreas.20of them received pancreatic tumor enucleation. The other13received middle segment pancreatectomy. The pathology types of these32cases is as follows:11cases are insulinoma,11cases are pancreatic cystadenoma,8cases are pancreatic cystic pseudopapillary tumor,2cases are pseudocyst and1case is adipoma. We collected the information of volume, position of tumors, blooding in the operation of enucleation, length of stay after operation and pancreatic fistula after operation.Results20of33patients received conservative resection of the proximal pancreas finished pancreatic tumor enuleation, of which,11cases located in the head of pancreas,1in uncinate process of pancreas and8in the neck and proximal body of pancreas. The other13cases finished middle segment pancreatectomy because of the injury of main pancreatic duct during the operation of pancreatic tumor enuleation in the neck and proximal body of pancreas. There are8cases having the tumors near the main pancreatic duct, of which,5caused injury of main pancreatic duct during operations and had to do the main pancreatic duct repair.23of32cases happened postoperative pancreatic fistula after the operation, including15patients after the pancreatic tumor enuleation and8patients after the middle segment pancreatectomy.7of8cases having tumors near the main pancreatic duct happened postoperative pancreatic fistula after enucleation.5patients received main pancreatic duct repair had severe postoperative pancreatic fistula, the maximum drainage volume of peritoneal fluid was up to1200ml/day. The pancreatic fistula in23cases is defined as A-B grade pancreatic fistula according to the standard of International Study Group on Pancreatic Fistula(ISGPF), because of the long drainage duration(the drainage time of pancreatic fistula patients varies from5days to292days), though there is no obvious peritoneal infection.2patients received cholecystectomy during the operation because of tumors near to common bile duct, one of them happened biliary fistula and repaired during the operation.5patients happened delayed gastric emptying(DGE) and1patient happened hemorrhage after operation. All of the complications were cured after symptomatic treatment. The average follow-up time of patients mentioned above is45.7months(from7months to150months). All patients are survived with no tumor recurrence and metastasis, with no symptoms of new-onset diabetes mellitus and dysfunction of exocnne pancreas.ConclusionIt is feasible and safe to do conservative resection for benign and borderline tumor of the proximal pancreas, even though the tumor is large and near main pancreatic duct. The rate of pancreatic fistula is high after the conservative resection compared with pancreatoduodenectomy and distal pancreatectomy, but it is safe for patients through the successful drainage. The conservative resection for pancreatic benign and borderline tumors of the proximal pancreas has the advantages on the operation time, operation blooding, complications such as peritoneal infection, events of death compared with conditional operations such as panreatoduodenectomy. Conservative resection is benefit to keep pancreas in good condition because of the least injury of pancreas during the operation.