Most Total Pancreatectomies for Pancreatic Cancer Can Be Replaced by Whipple Over The Splenic Artery (WOTSA)

10:40-11:00, Room 101 (101講堂)

Speaker

Professor

Yu-Wen Tien
MD, PhD

田郁文 教授

Director, Division of General Surgery,
National Taiwan University Hospital

Abstract - 

Most Total Pancreatectomies for Pancreatic Cancer Can Be Replaced by Whipple Over The Splenic Artery (WOTSA)

BACKGROUNDS

Total pancreatectomy has been increasingly performed for pancreatic head cancer involving neck/body. Most total pancreatectomies were performed because of the need to resect both the gastroduodenal and splenic arteries for a complete resection instead of extensive tumor involvement of the (nearly) whole pancreas. Spleen-preserving distal pancreatectomy with excision of splenic artery and vein ─ Warshaw’s procedure has been safely performed for decades. Theoretically, spleen- & distal-pancreas-preserving pancreaticoduodenectomy with excision of proximal segment of splenic artery and vein can also be performed.

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METHODS

Spleen- & distal pancreas-preserving pancreaticoduodenectomy with excision of splenic artery and vein was performed in 20 consecutive patients initially planned for total pancreatectomy. 

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RESULTS

There were 2 (8.3%) grade B postoperative pancreatic fistula and 4 gastric stasis (2 grade A and 2 grade B) but no reoperation because of infarction of pancreas and/or spleen remnant within 6 months after operation. Pathology showed pancreatic transection margin clearance is more than 5mm in all of the 20 patients operated for pancreatic cancer. At six months after operation, DM medication is none in 12, OHA in 9, and insulin in 3 studied patients.

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CONCLUSIONS

Distal-pancreas & spleen-preserving pancreaticoduodenectomy with excision of splenic artery and vein can be safely performed and effectively achieve adequate pancreatic transection margin clearance and conservation of pancreatic endocrine function. In consideration of this new procedure, most total pancreatectomies for primary pancreatic cancer are not necessary or even harmful.