Partial pancreatic tail preserving subtotal pancreatectomy forpancreatic cancer: Improving glycemic control and quality of lifewithout compromising oncological outcomes

BACKGROUND Total pancreatectomy (TP) is usually considered a therapeutic option forpancreatic cancer in which Whipple surgery and distal pancreatectomy areundesirable, but brittle diabetes and poor quality of life (QoL) remain majorconcerns. A subset of patients who underwent TP even died due to severehypoglycemia. For pancreatic cancer involving the pancreatic head and proximalbody but without invasion to the pancreatic tail, we performed partial pancreatictail preserving subtotal pancreatectomy (PPTP-SP) in selected patients, in order toimprove postoperative glycemic control and QoL without compromisingoncological outcomes.AIM To evaluate the efficacy of PPTP-SP for patients with pancreatic cancer.METHODS We retrospectively reviewed 56 patients with pancreatic ductal adenocarcinomawho underwent PPTP-SP (n = 18) or TP (n = 38) at our institution from May 2014to January 2019. Clinical outcomes were compared between the two groups, withan emphasis on oncological outcomes, postoperative glycemic control, and QoL.QoL was evaluated using the European Organization for Research and Treatmentof Cancer Quality of Life Questionnaire (EORTC QLQ-C30 and EORTC PAN26).All patients were followed until May 2019 or until death.RESULTS A total of 56 consecutive patients were enrolled in this study. Perioperativeoutcomes, recurrence-free survival, and overall survival were comparablebetween the two groups. No patients in the PPTP-SP group developed cancerrecurrence in the pancreatic tail stump or splenic hilum, or a clinical pancreaticfistula. Patients who underwent PPTP-SP had significantly better glycemiccontrol, based on their higher rate of insulin-independence (P = 0.014), lowerhemoglobin A1c (HbA1c) level (P = 0.046), lower daily insulin dosage (P < 0.001),and less frequent hypoglycemic episodes (P < 0.001). Global health was similar inthe two groups, but patients who underwent PPTP-SP had better functional status(P = 0.036), milder symptoms (P = 0.013), less severe diet restriction (P = 0.011),and higher confidence regarding future life (P = 0.035).CONCLUSION For pancreatic cancer involving the pancreatic head and proximal body, PPTP-SPachieves perioperative and oncological outcomes comparable to TP in selectedpatients while significantly improving long-term glycemic control and QoL.

Multi-item EOQ model for fresh fruits with preservation technology investment,time-varying holding cost,variable deterioration and shortages

In a fruit wholesale shop,a fruiterer needs to maintain huge inventory of different ranges of fruit items for customers because of uncertainty in consumer preferences and behaviour.But demand of them may differ and different EOQ models for each item are required for optimal level of EOQ.This paper presents a single inventory model to assimilate these varieties.It is assumed that many fruit items bear constant rate of deterioration,some are with time proportional deterioration and some do not deteriorate.To control deterioration of the units in inventory,the advanced preservation technology is considered.The proposed single inventory model of this paper incorporates composite and heterogeneous features of multiple items and presents analysis for obtaining optimal level for output model parameters.