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Organ preserving pancreatic resections offer better long-term conservation of pancreatic function at the expense of high perioperative major morbidity: a fair trade-off for benign or low malignant potential pancreatic neoplasms—a single-center experience

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Abstract

Background

Standard pancreatic resections (SPRs) might have long-term deleterious effects on pancreatic function, without added oncological advantage in low malignant potential (LMP) or benign neoplasms. This study aimed to evaluate outcomes following organ-preserving pancreatic resections (OPPARs) and SPRs.

Method

Post hoc analysis of patients undergoing OPPAR or SPR for benign or LMP pancreatic tumors from January 2011 to January 2020 at Tata Memorial Hospital, Mumbai.

Results

Thirty-six and 114 patients were identified in OPPAR and SPR groups respectively. The overall morbidity (58.3% vs 43.9%, p-0.129) was comparable. Major morbidity (41.7% vs 21.9%, p-0.020), post-operative pancreatic fistula (POPF) (63.9% vs 35.1%, p-0.002), and clinically relevant POPF (41.7% vs 20.2%, p-0.010) were significantly higher with OPPAR. Post-operative endocrine insufficiency (14.9% vs 11.1%, p-0.567), exocrine insufficiency (19.3% vs 0%, p-0.004), and requirement of long-term pancreatic enzyme replacement (17.5% vs 0%, p-0.007) were higher in SPRs. Comparing left-sided and right-sided resections in the entire cohort, incidence of endocrine insufficiency was 17.1% vs 11.2% (p-0.299) and that of exocrine insufficiency was 8.6% vs 20% (p-0.048) respectively.

Conclusion

OPPAR is associated with high post-operative major morbidity and pancreatic fistula rate but offers long-term benefit due to better preservation of pancreatic function than SPR. The incidence of exocrine insufficiency is higher in right sided as compared to left-sided pancreatic resections.

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Acknowledgements

Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India

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Author notes

  1. Vikas Gupta and Manish S. Bhandare have contributed to the manuscript equally and are joint first authors.

Authors and Affiliations

  1. Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, 400012, Maharashtra, India

    Vikas Gupta, Manish S. Bhandare, Vikram Chaudhari, Amir Parray & Shailesh V. Shrikhande

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Contributions

V. G., M. B., V. C., and S. S. were involved in the conception and design of the work.

V. G. and M. B. involved in acquisition, analysis, interpretation of data, and manuscript preparation.

M. B., V. C., and S. S. involved in critical revision of the manuscript.

All authors read and approved the manuscript.

Corresponding author

Correspondence to Manish S. Bhandare.

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Ethics approval and consent to participate

The data of the present study were collected in the course of common clinical practice, and accordingly, the signed informed consent was obtained from each patient for any surgical and clinical procedure. The study protocol was in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments. Because this was a retrospective study, formal consent for this study is not required and no approval of the institutional research committee was needed.

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Gupta, V., Bhandare, M.S., Chaudhari, V. et al. Organ preserving pancreatic resections offer better long-term conservation of pancreatic function at the expense of high perioperative major morbidity: a fair trade-off for benign or low malignant potential pancreatic neoplasms—a single-center experience. Langenbecks Arch Surg 407, 1507–1515 (2022). https://doi.org/10.1007/s00423-022-02491-y

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