The present study, to the best of our knowledge, was the first bibliometric analysis on organ-preserving pancreatic resection via the WOS database. Our study was expected to give a deeper understanding and shed light on the future research of organ-preserving pancreatic resection.
Along with the increasing incidence of pancreatic borderline malignant tumors such as neuroendocrine tumor and pancreatic cystic tumor, organ preserving pancreatic surgery has drawn more and more attention in recent years. Another probable reason for the spotlight on organ preserving pancreatic surgery is the advancement of laparoscopic and robotic surgery, which has dramatically changed the landscape of organ preserving pancreatic resection. According to the preserved organ, organ-preserving pancreatic resection could be chiefly categorized as surgery approaches preserving pancreatic function including central pancreatic resection, pancreatic enucleation, and pancreatic segment resection; and surgery approaches preserving peripheral organ function including pylorus preserving pancreatoduodenectomy, splenic-preserve distal pancreatectomy and duodenum-preserving pancreatic head resection. More than 150 of the 200 most-cited articles were clinical studies. The exocrine and endocrine dysfunction were the primary consideration for the long-term analysis of organ-preserving pancreatic resection. Several specific complications for the specific surgical approach, such as gastric emptying dysfunction[18] in pylorus preserving pancreatoduodenectomy, massive bleeding in splenic-preserving distal pancreatectomy, biliary injury in duodenal-preserving pancreatic head resection, pancreatic fistula in pancreatic enucleation, central pancreatectomy and duodenal-preserving pancreatic head resection were the main considerations in the study design. More basic research could provide us with more hints on handling the complications of organ-preserving pancreatic resection. To our disappointment, none of the T200 articles focused on basic research. The analysis of the clinical studies via the IDEAL stage framework showed that along with the development of organ-preserving pancreatic resection, the main theme of the clinical studies shifted from the short-term outcomes such as feasibility and safety to the long-term outcomes such as life quality. Articles got the highest average citations in 3–5 years after their publication, indicating that it usually took 3–5 years for a new technology, ideas, or viewpoints to be widely accepted in organ-preserving pancreatic resection. As organ preserving pancreatic resection was mainly applied to patients with benign or borderline malignant diseases, the survival outcomes were relatively less studied than those of pancreaticoduodenectomy and distal pancreatectomy with splenectomy for malignant diseases. The long-term outcome studies mainly focused on quality of life, exocrine insufficiency, and endocrine insufficiency.
Annals of Surgery was expected to be the most impactful journal in pancreatic surgery. It also had the second largest number of top cited articles. These articles investigated the efficacy and prognosis of pylorus preserving pancreaticoduodenectomy[19–25, 9, 26, 27], pancreatic segment resection[28–32], duodenum-preserving pancreatic head resection[33, 21, 34, 31] and some other procedures contributing to functional preservation[35–37, 27, 32]. We also found that Journal of Gastrointestinal Surgery ranked first in list of the most productive journals. It is a well-known and widely recognized journal in the realm of gastrointestinal and pancreatic surgery. East Asian, the USA and Europe were considered as the most prolific areas, which was similar to the bibliometric analysis on pancreaticoduodenectomy[38]. Buchler MW and Fernandez-cruz L were expected to be the two most influenced scholars. Studies concerning about pancreatic head resection, pylorus preserving pancreatoduodenectomy and pancreatic enucleation constituted Buchler’s top-cited articles[39–41, 33, 42–49, 16, 50–55]. The analysis of productive authors may identify the well-recognized authors in the area. Moreover, the co-authorship bubble map analyzed was expected to assess the collaborations with leading authors[56]. Of note, international cooperations were still insufficient. Most cooperations were taken in the same institution or country.
Keyword co-occurrence analysis was considered as an essential procedure in bibliometric analysis which could make visualized depiction of the research trends and distribution of topics[57, 58, 10, 59]. The most frequent keywords were analyzed to signify the research hotspot. Classical keywords including “risk factor” and “quality of life” still ranked high in the list of the most frequently used keywords. “Pancreaticoduodenectomy” remained to be the hot keyword as it was usually compared with the organ preserving pancreatic resection such as enucleation, duodenum preserving pancreatic head resection, and pylorus preserving pancreaticoduodenectomy. Notably, some keywords, including “fistula”, “conservation” and “international study group” were burst keywords in recent 10 years. One possible reason for the hot discussion on “fistula” might be that it was one of the most common and severe postoperative complications after organ-preserving pancreatic resection[60, 17, 61, 16, 62, 63]. Meanwhile, as the development of laparoscopic and robotic operation techniques, the conservation of organ function became a research trend in recent years[64, 65]. It was also indicated that international multi-centered study with larger sample size were more and more common in recent years.
Some limitations should be reminded in the present study. First, the study was performed with publications limited in Web of Science database, articles not collected by WOS might be overlooked. Second, some records might have been missed probably because their titles, keywords or abstracts did not meet our literature search paradigm. The number of retrieved articles might be somewhat less than the actual number. Third, some important but new articles might be missed for their relatively small number of citations, especially for the ones published in the recent 2 years. Moreover, as the initially planned organ preserving pancreatic surgery might convert to formal pancreatic resection (PD, DP or TP) due to intraoperative difficulties such as insurmountable adhesion and uncontrollable bleeding, few RCT has been published. The “crossover” patients should also be reminded when interpreting the clinical study results.