Pancreas with high pancreatic fistula risk, pancreatoduodenectomy or pancreatectomy? Cohort retrospective study

   Aim. To compare treatment outcomes and quality of life in patients undergoing pancreatoduodenectomy and pancreatectomy with risk of postoperative pancreatic fistula > 50 % according to the UA-FRS scale.

   Materials and methods. The study involved the results of treatment of 14 patients with neoplasms of the hepatopancreaticoduodenal zone, who were intraoperatively chosen to undergo pancreatectomy instead of pancreatoduodenectomy. In all patients, the risk of forming a pancreatic fistula after surgery was ≥ 50 % (UA-FRS). The experimental group consisted of 14 patients comparable in diagnosis, age, and comorbidities, who underwent pancreatoduodenectomy with the same risk of pancreatic fistula.

   Results. Complications ≥ IIIa according to Clavien–Dindo were observed in 6 patients (42.8 %) in the pancreatectomy group and in 8 patients (51.7 %) in the resection group. 5 patients (35.7 %) in the resection group revealed postoperative pancreatic fistula of class B and C, according to ISGPS. Length of hospital stay after surgery and 30-day mortality did not differ between groups. Quality of life after surgery had no pronounced differences between the groups according to most scales. Symptoms related to digestive disorders in those who underwent pancreatoduodenectomy were more pronounced. Patients in the pancreatectomy group were more susceptible to symptoms associated with diabetes mellitus, and experienced greater financial difficulties.

   Conclusion. Pancreatectomy fails to provide a significant reduction in the incidence of postoperative complications and mortality. In exceptional situations, increasing the extent of surgery to pancreatectomy may be the right solution, with comparable results, without compromising quality of life. Prior to surgery, pancreatectomy should not be considered as the main planned extent of surgery. The final decision on the extent of intervention should be made intraoperatively by a multidisciplinary team. Preserving part of the pancreas is essential, if possible.

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