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Extensive (subtotal) distal pancreatectomy for pancreatic ductal adenocarcinoma: a propensity score matched cohort study of short- and long-term outcomes compared with those of conventional distal pancreatectomy

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Abstract

Purpose

Extensive distal pancreatectomy (ExDP) can transect the pancreatic parenchyma more from the right side than conventional distal pancreatectomy (CDP) can. This study aimed to evaluate the short- and long-term outcomes of ExDP for pancreatic ductal adenocarcinoma (PDAC) of the pancreatic body, located adjacent to the portal vein (PV).

Methods

Medical records of 98 patients who underwent ExDP (n = 15) or CDP (n = 83) for PDAC were retrospectively reviewed. Short- and long-term outcomes of the two groups were compared. Propensity score matched analysis was additionally performed to minimize the impact of treatment allocation bias.

Results

In the total cohort, the CDP group had a significantly higher proportion of pancreatic tail lesions (P < 0.01), higher proportion of males, and larger tumor size. Of the 15 patients who underwent ExDP, 11 could be matched. These differences of patients’ characteristics were not observed after matching. Before and after matching, the duration of surgery, blood loss, rate of morbidity including pancreatic fistula, and postoperative course were comparable between the groups. The rate of recurrence and recurrence pattern were also not significantly different between the groups. ExDP for PDAC of the pancreatic body near the PV did not increase local or lymph node recurrence. The disease-free and overall survival did not differ between the groups.

Conclusions

Surgical and oncological outcomes after ExDP for PDAC were acceptable and comparable to those after CDP. ExDP is a feasible procedure, and could be an option for the treatment of PDAC of the pancreatic body near PV.

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Authors and Affiliations

  1. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Yusuke Watanabe, Kohei Nakata, Yasuhisa Mori, Noboru Ideno, Naoki Ikenaga, Takao Ohtsuka & Masafumi Nakamura

  2. Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan

    Yasuhisa Mori

  3. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan

    Takao Ohtsuka

Authors
  1. Yusuke Watanabe
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  2. Kohei Nakata
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  3. Yasuhisa Mori
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  4. Noboru Ideno
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  5. Naoki Ikenaga
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  6. Takao Ohtsuka
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  7. Masafumi Nakamura
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Contributions

Yusuke Watanabe and Kohei Nakata: study conception and design, acquisition of data, and drafting manuscript. Yusuke Watanabe, Kohei Nakata, Yasuhisa Mori, Noboru Ideno, Naoki Ikenaga, Takao Ohtsuka: analysis and interpretation of data. Masafumi Nakamura: critical revision of manuscript.

Corresponding author

Correspondence to Masafumi Nakamura.

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Conflict of interest

The authors declare no competing interests.

Ethics approval

This study was approved by the ethics committee of Kyushu University (approval number 2019–089).

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Informed consent was obtained from all individual participants included in the study.

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Watanabe, Y., Nakata, K., Mori, Y. et al. Extensive (subtotal) distal pancreatectomy for pancreatic ductal adenocarcinoma: a propensity score matched cohort study of short- and long-term outcomes compared with those of conventional distal pancreatectomy. Langenbecks Arch Surg 407, 1479–1488 (2022). https://doi.org/10.1007/s00423-022-02453-4

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  • DOI: https://doi.org/10.1007/s00423-022-02453-4

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