Middle segment pancreatectomy: Does it deserve a second chance? Report of three cases and review of the literature

Abstract

Introduction and importanceMeddle segment pancreatectomy (MP) is a parenchyma-sparing surgical procedure that has recently been proposed for treatment of benign or attenuated malignant tumors. However, this procedure is not fully recognized. Case presentationWe herein report 3 patients undergoing MP for tumors of pancreas body and tail. The first patient was a 38-year-old woman with a neuroendocrine tumor, the second was a 42-year-old woman with a serous cystic neoplasm and the 3rd patient was 57 years old, with mucinous cystadenoma.A MP with spleen preservation was performed in the 3 patients, with ligatures of splenic vessels in the first patient. Only one patient developed a pancreatic fistula, which was managed medically. In our 3 patients, no endocrine or exocrine insufficiency was observed, but the first patient showed a disease recurrence with liver metastasis 3 years after surgery. Clinical discussionMiddle pancreatectomy can not only avoid the pancreatic effects of extensive resections, but it is also a technique that has a very low operative or postoperative mortality rate. ConclusionMP is a feasible, safe procedure with several advantages, but which unfortunately remains rarely practiced.