Abstract
BackgroundPancreaticoduodenectomy and distal pancreatectomy are radical procedures for pancreatic lesions with high postoperative morbidity and mortality even in experienced hands. Central pancreatectomy is an alternative less radical procedure for centrally located pancreatic lesions that are benign or have a low malignant potential. It involves removing the central portion of the pancreas and has the advantage of preserving the pancreatic parenchyma, thereby decreasing the postoperative endocrine and exocrine insufficiencies.MethodsWe conducted a prospective study of six cases of central pancreatectomy in the Department of Surgical Gastroenterology and Liver Transplant, Government Stanley Medical College, India, between the years 2015 and 2019. All patients with lesions in the neck and proximal body of the pancreas were clinically and radiologically evaluated, and those with benign or borderline malignant lesions underwent central pancreatectomy by a standardized technique.ResultsThe mean age of the patients was 27.8 years (range: 14 years - 37 years). Most of the patients were females (66.6%). The most common presenting symptom was abdominal pain, and the most common diagnosis was solid pseudopapillary neoplasm (83.3%). The mean diameter of the lesion was 6.1 cm. All patients underwent pancreaticojejunostomy of the distal stump. The median operative time and the blood loss were 310 minutes and 85 ml, respectively. Two patients developed biochemical postoperative pancreatic fistula, and in the long-term follow-up, none of them developed endocrine or exocrine insufficiency.ConclusionCentral pancreatectomy is a safe and effective alternative for benign and low-grade lesions in the neck and body of the pancreas in which the head of the pancreas and a significant portion of the distal body and tail of the pancreas is uninvolved. Standardization of this pancreas-preserving procedure will result in better outcomes.
Highlights
Traditional surgeries for pancreatic lesions include pancreaticoduodenectomy (PD) and distal pancreatectomy with or without splenectomy
Pancreas-preserving resections are surgeries that are aimed at preserving pancreatic parenchyma, thereby decreasing the surgical complications and the postoperative endocrine and exocrine insufficiencies in the long term
We report our experience with six cases of central pancreatectomy done for benign lesions in the neck and proximal body of the pancreas
Summary
Traditional surgeries for pancreatic lesions include pancreaticoduodenectomy (PD) and distal pancreatectomy with or without splenectomy. These surgeries carry a significant morbidity and mortality risk. Pancreas-preserving resections are surgeries that are aimed at preserving pancreatic parenchyma, thereby decreasing the surgical complications and the postoperative endocrine and exocrine insufficiencies in the long term. Pancreaticoduodenectomy and distal pancreatectomy are radical procedures for pancreatic lesions with high postoperative morbidity and mortality even in experienced hands. Central pancreatectomy is an alternative less radical procedure for centrally located pancreatic lesions that are benign or have a low malignant potential. It involves removing the central portion of the pancreas and has the advantage of preserving the pancreatic parenchyma, thereby decreasing the postoperative endocrine and exocrine insufficiencies
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