Clinical efficacy of total pancreatectomy for pancreatic cancer (2017)

Objective
To investigate the clinical efficacy of total pancreatectomy (TP) for pancreatic cancer.


Methods
The retrospective descriptive study was conducted. The clinicopathological data of 11 patients who underwent TP for pancreatic cancer in the First Affiliated Hospital of Harbin Medical University from March 2009 to January 2016 were collected. Patients received planned TP or unplanned TP and digestive tract reconstruction using biliojejunal end-to-side anastomosis and side-to-side gastrojejunostomy. Observation indicators included: (1) treatment situations; (2) follow-up situation. Follow-up using outpatient examination and telephone interview was performed to detect the level of fasting blood glucose, glycosylated hemoglobin, dosages of insulin and pancreatic enzymes, symptoms of emaciation and diarrhea and patients′ prognosis up to November 2016. Measurement data were represented as ±s, average (range) and M (range).


Results
(1) Treatment situations: all the 11 patients underwent successful TP, including 4 undergoing planned TP due to pancreatic multiple space-occupying lesions by preoperative imaging examination and 7 undergoing unplanned TP. Two patients received partial resection of the superior mesenteric vein and artificial vascular replacement due to tumor invading superior mesenteric vein. Two patients without cholangiectasis received external drainage through intraoperative biliary stent placement, and drainage tube was removed at month 1 postoperatively. Operation time was 270-640 minutes, with an average of 450 minutes. Volume of intraoperative blood loss was 200-1 500 mL, with an average of 564 mL. Five patients had intraoperative blood transfusion, with volume of 400-1 600 mL. Results of postoperative pathological examination of 11 patients: R0 and R1 resection were respectively detected in 10 and 1 patients; 4 and 7 patients were in stage ⅡA and ⅡB, showing pancreatic ductal adenocarcinoma. Number of lymph node dissected with an average of 17.2±2.3 per case. Seven patients were complicated with local lymph node metastases, with a number of 2.1 per case. Three of 11 patients received postoperative 6-cycle chemotherapy regimens of gemcitabine and cisplatin. Four patients with postoperative complications were improved by conservative treatment, including 2 with infection, 1 with bile leakage and 1 with delayed gastric emptying, without death. Duration of hospital stay was 15-56 days, with an average of 24 days. (2) Follow-up situation: 11 patients were followed up for 5-24 months. During follow-up, levels of fasting blood glucose and glycosylated hemoglobin were respectively 5.0-10.0 mmol/L and 5.4%-10.4%, with averages of 7.6 mmol/L and 7.5%. Dosages of insulin and pancreatic enzymes were respectively 18.0-28.0 U/d and 450-900 mg/d, with averages of 22.7 U/d and 640 mg/d. During follow-up, 4, 5 and 2 patients had respectively increased, normal and decreased appetites. Three, 4 and 4 patients had respectively increased, unchanged and decreased body weights. Symptoms of diarrhea, fatty liver (outpatient reexamination) and hypoglycemia were occurred in 2, 2 and 1 patients, respectively. Of 11 patients, 2 had tumor-free survival, and 9 had survival with tumor, with a median survival time of 12 months (range, 5-23 months), including 3 with abdominal metastases or recurrence, 2 with liver metastases, 2 with pulmonary metastases and 2 with retroperitoneal lymphatic metastasis.


Conclusion
TP is safe and feasible for pancreatic cancer, it can also provide better quality of life for patients under conditions of regulating blood glucose and supplying pancreatic enzyme.


Key words: 
Pancreatic neoplasms; Total pancreatectomy; Quality of life