Abstract:

Objective

To evaluate the safety and efficacy of total pancreatectomy in the treatment of pancreatic cancer.

Methods

Clinical data of 4 patients with pancreatic cancer who underwent total pancreatectomy in the First Affiliated Hospital of Guangxi Medical University from June 2019 to March 2023 were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them， 1 patient was male and 3 female， aged from 58 to 71 years， with a median age of 62 years.Perioperative status and postoperative complications were observed.

Results

Total pancreatectomy via the arterial route was successfully performed in all 4 patients， including 2 cases of open spleen-preserving total pancreatectomy， 1 case of laparoscopic spleen-preserving total pancreatectomy and 1 case of robot-assisted total pancreatectomy with spleen resection.The operation time was 488-784 min， with a median time of 643 min.Intraoperative blood loss was 200-900 ml， with a median blood loss of 400 ml.Postoperative pathological examination showed that 3 cases were diagnosed with pancreatic ductal adenocarcinoma and 1 case of pancreatic adenosquamous carcinoma.Postoperatively，4 patients developed brittle diabetes.Insulin pump was used to control the blood glucose level， and the fasting blood glucose level was maintained at 5-8 mmol/L.Meantime， pancreatin preparation was supplemented to support pancreatic exocrine function.No postoperative gastric emptying disorder， bile leakage and abdominal bleeding were reported.The length of postoperative hospital stay was 13.0-21.0 d， with a median time of 15 d.No patient died within postoperative 30 d.Postoperative follow-up time was ranged from 2.0 to 46.0 months，with a median time of 40.5 months.One case died of ketoacidosis at 4 months after operation.The remaining 3 cases obtained stable blood glucose levels， acceptable quality of life and no tumor recurrence.

Conclusions

Total pancreatectomy is safe and feasible treatment if surgical indications are properly managed.Long-term management of postoperative blood glucose level and recovery of gastric function are critical factors affecting patients’ quality of life.

Key words: Pancreatic neoplasms, Robotic total pancreatectomy, Laparoscopic total pancreatectomy, Blood glucose, Fragile diabetes, Safety, Complication