Median Pancreatectomy

Abstract

Summary: Surgical resections traditionally involves pancreaticoduodenectomy and distal pancreatectomy, leading to substantial loss of unaffected endocrine and exocrine tissue of pancreas. They are also associated with significant morbidity (diabetes). To minimize the loss of normal pancreatic tissue, limited resections in the form of central (median) pancreatectomy may be done alternatively. We would hereby like to submit the surgical video of this procedure. Case: A 62 yr female without comorbidities, and being symptomatic with intermittent pain abdomen of 45 days duration. Patient was evaluated with ultrasound and CT abdomen which revealed heterogenous enhancing solid lesion in pancreatic neck. Endoscopic ultrasound was done which was suggestive of pancreatic head mass. Needle aspiration cytology revealed neuroendocrine tumour. After pre-operative work up, patient underwent Open Median(Central) pancreatectomy. Intra-operatively a 1.5x1.5 cm firm mass was found at the neck of pancreas. Rest of abdominal findings were normal. Pancreatic duct was dilated. Continuity of distal pancreas was established using a Roux en Y jejunal limb which was anastomosed with pancreatic duct. Blood loss of 250 ml. Immediate perioperative period was uneventful. As an institutional protocol, feeding jejunostomy was placed in the jejunum. Feeds were started on post-operative day(POD)-3 through feeding jejunostomy and was progressively tapered as oral ingestion improved satisfactorily. Histopathological report was suggestive of Grade I, Neuroendocrine tumour of pancreas. Patient had grade II complication according to Clavien Dindo grading system. Follow-up till 16 months patient is alive having an event free survival. Conclusion: Limited pancreatic resections such as central (median) pancreatectomy may be done in selected cases with pancreatic neuro-endocrine and benign tumors affecting neck and body of pancreas with advantages of retaining uninvolved portions of pancreas.