Between March 2005 and May 2018, patients with PNENs who underwent laparoscopic organ-sparing pancreatectomy in our institution were reviewed. The preoperative assessment included a computed tomographic (CT) scan, a pancreatic magnetic resonance imaging (MRI),and an endoscopic ultrasound (EUS) or with fine-needle aspiration(FNA).The preoperative anesthesic evaluation was done using the American Society of Anesthesiology guidelines.
Preoperative, operative, and postoperative data were prospectively collected and retrospectively analyzed. The data included patient demographics, clinical presentation, intraoperative variables (type of resection, operative time, estimated blood loss (EBL), conversion to open operation, blood transfusion requirement), postoperative hospital stay, morbidity and mortality (within 30 days from surgery), readmission rate (within 30 days from hospital discharge), pathologic findings, and long-term follow-up.
Pancreatic fistula (PF) was assessed according to the International Study Group on Pancreatic Fistula recommendations . Postoperative morbidity was graded using the Clavien-Dindo classification. Graded Ⅰand Ⅱwere grouped as minor and graded Ⅲ–Ⅴ was considered as major complications .
Patients were followed up via out-patient examination. The final follow-up was taken in August 2018. Recurrence or distant metastasis was diagnosed pathologically by surgical resection, biopsy, or cytology and/or radiological examination. Pancreatic endocrine insufficiency was defined as new-onset diabetes and worsening diabetes. Patients with diarrhea and steatorrhea, weight loss, and taking of pancreatic enzyme supplementation were considered to have pancreatic exocrine insufficiency.
The Institutional Review Board of Zhejiang provincial people’s Hospital approved this study protocol.
All indications of operation were discussed by a multidisciplinary team board. The type of pancreatic resection was based on the locations and size of the tumors. Laparoscopic enucleation(LE) was performed for the tumors located ≥ 3 mm distant from the Wirsung duct (WD). Laparoscopic central pancreatectomy(LCP) was performed for the tumors located in the neck-body of the pancreas < 3 mm from the WD and which allowed 5 cm of the tail of the pancreas to be preserved. When the remaining tissue of the distal pancreas was fibrotic or atrophic or < 5 cm long, laparoscopic spleen-preserving distal pancreatectomy(LSPDP) was performed. LSPDP was performed for tumors located < 3 cm from the distal end of the pancreas and < 3 mm from the WD.
The procedures were planned before surgery, but the final procedure was decided on during surgery based on a combination of macroscopic, intraoperative ultrasonographic findings, and intraoperative frozen section examination.
Patients were placed in supine position with the head slightly elevated. The surgeon and the second assistant who held the laparoscope stood on the right side of the patientand the first assistant stood on the left. Five trocars (three 5-mm trocars and two 10/12-mm trocars) are used; and the five trocars were arranged in a V shape[14–18].
Laparoscopic Enucleation,laparoscopic Spleen-preserving Distal Pancreatectomy, Laparoscopic Central Pancreatectomy
The surgical technique for LE, LSPDP, and LCP have been previously described in detail elsewhere [14–18].
Histopathological data, such as tumor size, tumor location, margin status, lymph node status, were also analyzed. Tumors were reviewed and graded based on mitotic count and Ki-67 index, according to the World Health Organization(WHO) classification and the European Neuroendocrine Tumor Society(ENETS) TNM classification.
Continuous clinicopathological data were expressed as mean ± standard deviation or median (range) as appropriate. Categorical variables were reported as number and percentage. All statistical analyses were performed using SPSS version 19.0.