Subtotal Pancreatectomy for Cancer:Closure of the Pancreatic Remnant WithStaplers

摘要

This paper presents a 2-year series of 26 consecutive pancreatectomies for periampullary cancer where thepancreatic tail was closed with a stapler in order to avoid complications related to a pancreatico-digestiveanastomosis. The follow-up period was 14 months or more. Seven patients developed operative complications.Pancreatic fistulas developed in 3 patients. The fistulas closed spontaneously in 2 of the patients after2-4 months, lntraabdominal abscesses developed in 4 patients and required surgical drainage. In 1 of thesepatients, the abscess eroded a large vessel with a fatal outcome resulting in an operative mortality rate of3.8%. A transient postoperative gastric stasis was observed in seven patients. Postoperative hospital medianstay was 27 days (range 10–83 days). Eighteeen patients have died after 4–30 months in recurrent disease andseven patients are alive after a follow-up period of 15–29 months. Pancreatic endocrine function seemed wellpreserved; diabetes mellitus has developed in only one patient. In conclusion, it appears that subtotalpancreatectomy with closure of the pancreatic remnant with staples gives a low morbidity and mortality.Although the conclusion should be tempered by the small number of patients, the results justify continuedevaluation of this technique with long-term follow-up.