Experiences in Central Pancreatectomy

Abstract

Background: Non-cancerous pancreatic lesions have been increasing, and function-preserving pancreatectomy may be an adequate approach to them. Recent advanced experience of major pancreatectomy has stimulated interest in central pancreatectomy (CP). Materials and Methods: Nineteen patients who underwent CP for benign and borderline malignant lesions of the pancreas from January 1990 to December 2007 were retrospectively reviewed. We also summarized recent literature reporting more than 10 cases of CP. Result: Nine patients (47.4%) experienced postoperative complications. Pancreatic leak was noted in 7 patients (36.8%). Two patients (10.5%) required reoperation due to intractable pancreatic leak and postoperative bleeding. No mortality was noted. During the follow-up period (median 35 months, range 3–182 months), only 1 patient (5.3%) developed new-onset diabetes after successful CP. In a comparative study, similar perioperative morbidity was noted between CP and extended distal pancreatectomy with splenectomy (extended DP-S); however, the operation time and postoperative hospital stay were significantly longer in the CP group and the incidence of new-onset diabetes was much lower in the CP group as compared with the DP-S group (p < 0.05). Conclusion: CP can be carefully selected as an appropriate surgical option for benign and borderline malignant lesions limited to the pancreatic neck area.

Central Pancreatectomy versus Spleen-Preserving Distal Pancreatectomy: A Comparative Analysis of Early and Late Postoperative Outcomes

“…Thus, CP appears to be a promising alternative in selected cases [30,31]. However, CP is an uncommon pancreatic resection (less than 3% of all pancreatic resections) even at high-volume centers [5,10,26,32].…”

“…Several studies comparing CP to distal pancreatectomy have shown a significantly increased rate of postoperative pancreatic fistulae after CP [9,13,33,[35][36][37], while in others, no differences were found [10-12, 14-17, 29, 32]. However, most of the latter studies showed an increased but not significant rate of postoperative pancreatic fistulae compared to distal pancreatectomy (21.4-44% for CP vs. 14-29% for distal pancreatectomy); significance may not have been reached due to the small number of patients analyzed [11,15,17,29,32]. Only a few statistically powered studies have shown that there is no difference between CP and distal pancreatectomy in terms of rates of postoperative pancreatic fistula development [10,12,14,16].…”

“…Intraoperative blood loss is widely considered to be comparable for the two surgical procedures [9, 12-14, 17, 29, 32, 33, 37], but some studies considered CP to have less blood loss [10,11,15,36], as was the case in the present study. Nevertheless, most of the comparative studies did not show any difference in postoperative hospital stay [9-12, 14, 17, 33, 36], but a few studies associated CP with a longer hospital stay [13,29,32,37].…”

Pylorus- and spleen-preserving total pancreatoduodenectomy with resection of both whole splenic vessels: feasibility and laparoscopic application to intraductal papillary mucin-producing tumors of the pancreas

“…Crippa et al [19] called a distal pancreatectomy in which the pancreas was divided at the level of the SMV-SV-PV confluence an ''extended'' distal pancreatectomy as opposed to a central pancreatectomy. Thus, we may specifically title Warshaw procedure used for this PpSpTPD as an ''extended'' Warshaw procedure, because the pancreas also was divided at the level of the SMV-SV-PV confluence, and the splenic artery and vein were securely controlled at the origin of the vessels [9].…”

“…In the case of laparotomy, an inverted L incision was usually made for surgical exploration, but only a small upper midline laparotomy (8-10 cm) was required for hepaticojejunostomy and duodenojejunostomy in the case of a laparoscopic approach. We regarded the whole surgical procedure as a combination of two different surgeries: SpDP with segmental resection of the splenic vessels (the so-called Warshaw's procedure) [9], and PpPD. After complete resection of the whole pancreas ( Fig.…”