Outcomes of simple and multivisceral pancreatic resection for benign and borderline malignant pancreatic and periampullary tumors

Abstract

Objective: Pancreatic resection (PR) offers the potential for cure in benign and borderline malignant pancreatic and periampullary tumors. However, long-term outcomes in this patient population have not been previously reported from Pakistan. This study evaluated the short- and long-term outcomes of PR for benign and borderline tumors of pancreatic and perimapullary origin. Methodology: This, a retrospective single-center cohort study, including 35 patients who underwent PR for benign or borderline malignant tumors between 2012 and 2024. Perioperative morbidity, mortality, recurrence, and survival outcomes were analyzed. Results: The median follow-up duration was 60 months (IQR 22–98). S-PR was performed in 29 patients (82.8%), including pancreaticoduodenectomy (n=27, 77.1%), distal pancreatectomy (n=5, 14.3%), and central pancreatectomy (n=3, 8.6%). Multivisceral pancreatic resection (MV-PR) was required in 6 patients (17.2%), involving concomitant colonic (n=2), hepatic (n=2), combined hepatic and colonic (n=1), and subtotal gastric (n=1) resections. Major postoperative complications occurred in 7 patients (20%), and clinically relevant postoperative pancreatic fistula developed in 3 (8.6%). In-hospital mortality occurred in 2 patients (5.7%): one following pancreaticoduodenectomy with type IV portal vein resection and one after MV-PR requiring right hepatectomy. Tumor recurrence occurred in 5 patients (14.3%) at a median of 20 months (IQR 7–21). The 10-year overall survival was 84% after S-PR and 67% after MV-PR (P=0.212), while 10-year disease-free survival was 87% and 60%, respectively (P=0.064). Among MV-PR patients, five remained alive and recurrence-free, with one achieving 144 months of follow-up. Conclusion: Pancreatic resection, including selected multivisceral resections, appears to be safe and potentially curative option when performed in carefully selected patients for benign and borderline malignant tumors in experienced centers. Abbreviations: NET: Neuroendocrine tumors; PR: Pancreatic resection; OS: Overall survival; DFS: disease free survival; GIST: Gastrointestinal stromal tumor; NF-PanNETs: Nonfunctional pancreatic neuroendocrine tumors; S-PR: Simple pancreatic resection; MV-PR: Multivisceral pancreatic resection; PD; Pancreatodudenectomy.