Pancréatectomie médiane : résultats d’une série de 11 patients

Abstract

Aim of the study: To report a new series of medial pancreatectomy (MP), with analysis of early and long-term results. Patients and methods: From 1990 to 1999, 11 patients (mean age= 53 years, extremes: 28–70) – including 10 non-diabetic – underwent MP for neuroendocrine tumor ( n=5), intraductal papillary mucinous tumor (IPMT) ( n=3), serous cystadenoma, metastasis from renal cell carcinoma, and focal pancreatitis. The procedure included medial resection of variable extent, frozen section, and suture of the cephalic stump. The caudal stump was either anastomosed to the posterior gastric wall ( n=9), or closed when atrophic or very small ( n=2). Results: The mean length of resection was 7 cm (extremes: 4–15). The diagnosis suspected preoperatively was confirmed in 10 cases. In one patient, a suspected adenocarcinoma was actually a focal pancreatitis. No postoperative death occurred. Seven patients experienced complications: one delayed gastric emptying and 6 pancreatic fistulas (54%), including 3 associated with intra-abdominal collection. Two patients were reoperated to drain a pancreatic fistula. The mean hospital stay was 14 days (extremes: 10–21) without complications, and 30 days (extremes: 11–90) after complications. After a mean follow-up of 45 months (extremes: 7–130), only one patient initially non-diabetic experienced post-operative diabetes and needs enzyme therapy after a 15 cm-resection for IPMT. No patient developed isolated intrapancreatic recurrence. Conclusions: MP preserves efficiently pancreatic function and is associated with a low risk of intrapancreatic recurrence. Conversely, MP is associated with an high risk of pancreatic fistula.