Organ Preserving Pancreatectomy In The Treatment Of Benign Or Low-grade Malignant Pancreatic Tumor

Objective: To explore the clinical application value of organ preserving pancreatectomy in the treatment of benign or low-grade malignant pancreatic tumor.Methods: The clinical data of 99 cases with pancreatic benign or low-grade malignant tumor from January 2009 to January 2016 were retrospectively analyzed,including 38 insulinoma,10 mucinous cystadenoma,16 serous cystadenoma,6 intraductal papillary mucinous neoplasm,27 solid pseudopapillary tumor,1 nonfunctional neuroendocrine tumor and 1 paraganglioma.All patients were divided into organ preserving group and traditional surgery group according to the operative method.The organ preserving group(n=63)included 34 tumor enucleation(containing 3 laparoscopic),10 middle segmental pancreatectomy,10 spleenpreserving distal pancreatectomy(containing 2 laparoscopic,6 splenic vessel preservation,4 splenic vessel resection),6 pylorus preserving pancreaticoduodenectomy,3 duodenum-preserving pancreatic head resection.The traditional surgery group(n=36)included 10 pancreaticoduodenectomy(containing 2 laparoscopic /robotic),26 distal pancreatectomy with splenectomy(containing 8 laparoscopic).The safety and feasibility of organ preserving pancreatectomy were investigated by comparing the operation time,intraoperative blood loss,postoperative complication and postoperative hospital stay.Meanwhile,the protective effect of organ preserving pancreatectomy on the pancreatic endocrine and exocrine functions were investigated by comparing the incidence of new-onset diabetes mellitus,and requiring pancreatic enzyme substitution therapy postoperatively.Results: There were no statistical significance between the two groups in sex,age,concomitant type 2 diabetes mellitus,the location and size of tumor(P>0.05).Organ preserving group had a shorter mean operation time than traditional surgery group(162.9min vs 209.6min,P=0.019).Patients in the organ preserving group had significantly less intraoperative blood loss compared with the traditional surgery group(mean 240.8m L vs 383.3m L,P=0.012).The incidence of postoperative complications,pancreatic fistula,bleeding,abdominal infection,delayed gastric emptying in organ preserving group were 36.5%,27.0%,1.6%,4.8% and 3.2% respectively,and those of traditional surgery group were 36.1%,25.0%,2.8%,5.6% and 2.8%,respectively(all P>0.05).There had no reoperation and death in the two groups.The mean postoperative hospital stay of organ preserving group was significantly shorter than that of traditional surgery group(11.2d vs 14.4d,P=0.039).All patients had no recurrence or metastasis with a mean follow-up 34.4 months.Excluding patients with insulinoma in the two groups,the incidence of new-onset diabetes mellitus in organ preserving group(n=30)was significantly lower than that in traditional surgery group(n=31,3.3% vs 25.8%,P=0.026).Moreover,significantly fewer patients in the organ preserving group than in the traditional surgery group required pancreatic enzyme substitution therapy(1.6% vs 13.9%,P=0.023).The incidence of postoperative platelet abnormally elevated in spleen-preserving distal pancreatectomy was significantly lower than that in distal pancreatectomy with splenectomy(0 vs 38.5%,P=0.035).Conclusion: Organ preserving pancreatectomy is a safe and effective procedure in the treatment of benign or low-grade malignant pancreatic tumor.It can maximally preserve the pancreatic parenchymal and adjacent organs,avoid the excessive loss of pancreatic endocrine and exocrine functions,and preserve the function of spleen.It is worthily recommended in the clinical application.