Central Pancreatectomy: Significance of Vascularity on Anastomotic Integrity and a Note on Reconstructive Technique

Abstract

Central pancreatectomy is a pancreatic parenchymal sparing surgery usually indicated for benign and borderline malignant tumors of the neck and proximal body of the pancreas. Due to the presence of extensive intra-pancreatic spread, pancreatic parenchyma sparing procedures such as central pancreatectomy are invariably deferred in pancreatic malignancy. The need for management of two pancreatic stumps with a usually soft texture and non-dilated ducts, given the indications, increases the risk of pancreatic fistula and therefore morbidity. Proximal stump management is usually a closure either by suture or stapler with reinforcements; the technique preferred depends on the experience of the surgeon and is mostly extrapolated from distal pancreatectomy. Distal stump management is the Achilles' heel owing to the texture of the pancreas and pancreatic duct size. Need for additional mobilization may have a bearing on the perfusion of the pancreatic stump and hence may lead to clinically relevant leaks. The use of octreotide accentuating the said vascular insufficiency may not be an overstatement. Here we present a case of solid pseudopapillary tumor (SPT) of the neck and proximal body of the pancreas in which a central pancreatectomy with falciform patch closure of the proximal stump and binding pancreaticogastrostomy (PG) was contemplated and further we discuss the types of reconstruction with special reference to the vascular pattern of distal pancreas.

Is central pancreatectomy an effective alternative to distal pancreatectomy for low-grade pancreatic neck and body tumors: A 20-year single-center propensity score-matched case-control study

“…After resection, one of the critical issues in CP is the management of two pancreatic stumps. The proximal stump can be managed by suture ligation, or division with a stapler or pancreatico-enteric anastomosis, falciform or omental patch reinforced suture closure [ 5 ]. The challenging aspect of CP is the management of the distal pancreatic stump, given the short distal stump length and the small size of the pancreatic duct.…”

“…Since then, many surgeons have reported their experiences with CP [ 4 ]. The rate of postoperative pancreatic fistula (POPF) after CP is high because there are two cut surfaces and a small-diameter pancreatic duct in the distal pancreatic stump that need to be managed after CP [ 5 , 6 ]. Some reports have compared the outcomes of CP with those of DP [ 6 ]; hence, we wanted to compare the short- and long-term outcomes of CP with those of DP.…”