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
Moderator
Professor
Chiun-Sheng Huang
MD, PhD
黃俊升 教授
Chairman, Department of Surgery, National Taiwan University Hospital
Moderator
Professor
Kenneth Kenji Tanabe
MD, PhD
Chief, Division of Gastrointestinal and Oncologic Surgery, Massachusetts General 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.
METHODS
Spleen- & distal pancreas-preserving pancreaticoduodenectomy with excision of splenic artery and vein was performed in 20 consecutive patients initially planned for total pancreatectomy.
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.
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.