To compare clinical efficacy of three surgical procedures in the treatment of benign or low-grade malignant tumors in the neck and body of pancreas.

Clinical data of88 patients with benign or low-grade malignant pancreatic tumors admitted to the First Affiliated Hospital of Nanchang University from January 2009 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 20 patients were male and 68 female, aged from 10 to 77 years, with a median age of 46 years. According to surgical procedures, all patients were divided into the central pancreatectomy group (CP group, n=23), spleen-preserving distal pancreatectomy group (SPDP group, n=26) and distal pancreatectomy combined with splenectomy group (DPS group, n=39). The operation time and intraoperative blood loss among three groups were compared by one-way ANOVA. Paired comparison was performed by SNK-q test. The incidence rate of complications was compared by Chi-square test or Fisher's exact test.

The average operation time in the CP group was (232±54) min, significantly longer than (196±39) min in the SPDP group and (191±35) min in the DPS group (q=1.169, 3.591; P<0.05). Intraoperative blood loss in the CP and SPDP groups were (167±51) ml and (185±77) ml, significantly less than (253±130) ml in theDPS group (q=-6.537, -3.270; P<0.05). The overall incidence of complications in the CP group was 57%(13/23), significantly higher than 22%(5/26) and 23%(9/39) respectively in the SPDP and DPS groups (χ²=7.302, 6.700; P<0.016 7). The incidence of pancreatic fistula in the CP group was 57%(13/23), significantly higher than 12%(3/26) and 21%(8/39) in the SPDP and DPS groups (χ²=11.230, 7.985; P<0.016 7).The incidence of clinically relevant pancreatic fistula (grade B/C) in the CP group was 30%(7/23), significantly higher than 6%(4/65) in the SPDP+DPS group (χ²=9.157, P<0.05). The incidence of elevated Plt in the DPS group was 26%(10/39), significantly higher than 0 in the CP and SPDP groups (P=0.010, 0.004). No reoperation, operation-related death or portal vein thrombosis occurred in all three groups. The follow-up time was ranged from 12 to 167 months, with a median of 84 months. In the SPDP group,6 cases suffered from pancreatic endocrine insufficiency and 6 cases of pancreatic exocrine insufficiency, 7 and 8 cases in the DPS group, and 0 and 0 cases in the CP group, respectively. In the SPDP+DPS group, the incidence of postoperative pancreatic endocrine and exocrine insufficiency was 20%(13/65) and 22%(14/65), significantly higher than 0 in the CP group (P<0.001). All patients experienced no tumor recurrence or metastasis during follow-up.

For the benign or low-grade malignant tumors in the neck and body of pancreas, SPDP yields better short-term efficacy compared with DPS and CP, while CP has long-term advantage of properly preserving the endocrine and exocrine functions of pancreas.