Duodenum and ventral pancreas preserving subtotal pancreatectomy for low-grade malignant neoplasms of the pancreas: An alternative procedure to total pancreatectomy for low-grade pancreatic neoplasms

Table 1 Preoperative characteristics and final pathologic features of 23 patients in the duodenum and ventral pancreas preserving subtotal pancreatectomy and total pancreatectomy groups n (%)

Patient characteristics	DVPPST(n = 10)	TP (n = 13)	P vaule
Age (range, yr)	49 ± 16.9 (24-71)	56 ± 10.1 (40-70)	0.256
Gender (%)			0.680
Male	4 (40)	7 (54)
Female	6 (60)	6 (46)
Major comorbidity
CAD	0	1	1.000
COPD	1	2	1.000
DM	2	3	1.000
Hypertension	3	3	1.000
Preoperative symptoms
Incidental	0	2 (15)	0.486
Symptomatic (%)	10 (100)	11 (85)
Abdominal pain	4 (40)	6 (55)	1.000
Pancreatitis	1	4	0.339
Weight loss	1	4	0.339
Gastrointestinal symptoms	4	3	0.65
ASA score			1.000
I/II	7	10
III	3	3
Pathology (%)			0.411
IPMN	6 (60)	11 (85)
Low-grade moderate-grade dysplasia	2	1	0.515
High-grade dysplasia	3	4	0.644
Invasive carcinoma	1 (16.7)	5 (45.5)	0.333
Neuroendocrine tumor	2	1
G 2	2	1	1.000
SPT	2	1
Total invasive malignancy	1 (10)	5 (38.5)	0.179

CAD: Coronary artery disease; COPD: Chronic obstructive pulmonary disease; DM: Diabetes mellitus; IPMN: Intraductal papillary mucinous neoplasm; SPT: Pseudo-papillary tumor; DVPPSP: Duodenum and ventral pancreas preserving subtotal pancreatectomy.

Table 2 Intraoperative and postoperative outcomes of 23 patients after duodenum and ventral pancreas preserving subtotal pancreatectomy and total pancreatectomy

Operative characteristics	DVPPSP(n = 10)	TP (n = 13)	P vaule
Intraoperative transfusion (U)	0.20 ± 0.63 (0-2)	0.54 ± 1.05 (0-3)	0.379
Operative time (min)	232 ± 19.6 (215-255)	335 ± 32.3 (280-400)	< 0.001
Postoperative characteristics
DGE	0	1	1.000
Biliary fistula	0	1	1.000
Pancreatic fistula (B and C)	0	0	—
Overall morbidity	2	5	0.405
Major morbidity (≥ grade 3)	1	2	1
Reoperation	0	0	—
Readmission (30 d)	0	0	—
LOS	9.7 ± 3.8 (7-20)	11.7 ± 5.2 (8-26)	0.318
Mortality	0	0	—
Recurrence1(%)	2 (20%)	5 (38.5%)	0.405
IPMN	2/6	5/11	1.000

¹The recurrences of 2 patients in the DVPPSP group and 5 patients in the TP group occurred after surgery for IPMN. DGE: Delayed gastric emptying; LOS: Length of postoperative stay; DVPPSP: Duodenum and ventral pancreas preserving subtotal pancreatectomy.

Table 3 Postoperative condition of supplementary therapy of 23 patients after duodenum and ventral pancreas preserving subtotal pancreatectomy and total pancreatectomy

Parameters	DPPSP(n = 10)	TP (n = 13)	P vaule
Enzymes replacement (cps/d)	0.9 ± 2.0	9.2 ± 2.2	< 0.001
Total insulin dose (U/d)	6.4 ± 14.0	29.7 ± 9.3	< 0.001
Diarrhea or steatorrhea	2	4	0.660
Hyperglycemia	0	5	0.046

TP: Total pancreatectomy; DVPPSP: Duodenum and ventral pancreas preserving subtotal pancreatectomy.

Table 4 Postoperative condition of diabetes of 10 patients in the duodenum and ventral pancreas preserving subtotal pancreatectomy group

Parameters	DPPSP (n = 10)
New-onset diabetes	0 / 7
Worsen diabetes1	1/3
Diet to oral medication	—
Diet to insulin	—
Oral medication to insulin1	1/3

¹There was 3 out of 10 patients in DVPPSP group who had diabetes before surgery and were treated by oral medicine. DVPPSP: Duodenum and ventral pancreas preserving subtotal pancreatectomy.

Table 5 Quality of lives after duodenum and ventral pancreas preserving subtotal pancreatectomy and total pancreatectomy

Parameters	DVPPSP(n = 8)	TP (n = 8)	P vaule
Functional scale
Physical	95.0 ± 9.3 (80-100)	97.5 ± 7.1 (80-100)	0.554
Working ability	100	100	—
Cognitive	100	100	—
Emotional	98.4 ± 2.9 (93.8-100)	92.2 ± 8.0 (75-100)	0.057
Social	95.8 ± 7.7 (83.3-100)	85.4 ± 10.7 (66.7-100)	0.042
Global QoL	96.9 ± 6.2 (83.3-100)	88.5 ± 8.9 (75-100)	0.047
Symptom scale
Fatigue	4.2 ± 8.3 (0-22.2)	11.1 ± 11.7 (0-33.3)	0.196
Nausea and vomiting	0	6.3 ± 12.4 (0-33.3)	0.197
Pain	0	0	—
Appetite loss	0	20.8 ± 24.8 (0-66.7)	0.049
Dyspnea	0	0	—
Sleep disturbance	4.2 ± 11.8 (0-33.3)	12.5 ± 17.2 (0-33.3)	0.281
Constipation	0	4.2 ± 11.8 (0-33.3)	0.351
Diarrhea	4.2 ± 11.8 (0-33.3)	12.5 ± 24.8 (0-66.7)	0.405
Financial strain	0	8.3 ± 15.4 (0-33.3)	0.170

TP: Total pancreatectomy; QoL: Quality of life; DVPPSP: Duodenum and ventral pancreas preserving subtotal pancreatectomy.