John D Christein1, Rory L Smoot, Michael B Farnell. 1. Division of Gastroenterologic and General Surgery, Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minn, USA.
Abstract
HYPOTHESIS: Central pancreatectomy has been used sparingly because the spectrum of indications is quite narrow. Although historically used for traumatic pancreatic transection and chronic pancreatitis, it currently is reserved for selective management of pancreatic neck lesions that are benign or have low malignant potential. Varying morbidity rates have been published in the literature. Our objectives were to describe the technique and determine the safety and effectiveness of central pancreatectomy in the excision of benign or low-malignant potential lesions of the pancreatic neck. DESIGN: Retrospective clinicopathologic data review. SETTING: The Mayo Clinic surgical index was used to identify procedures matched for central, median, middle, or middle segment pancreatectomy. PATIENTS: Eight patients (4 men, 4 women) underwent central pancreatectomy between 1998 and 2004. INTERVENTION: Patients with pancreatic neck or proximal body masses underwent central pancreatectomy at the Mayo Clinic, Rochester, Minn. MAIN OUTCOME MEASURES: Patients were followed up closely for postoperative complications during the initial hospital admission. On follow-up, long-term endocrine and exocrine function were determined based on laboratory values and patient history. RESULTS: Abnormalities included 3 islet cell tumors, 2 serous cystadenomas, a mucinous cystadenoma, a lymphoepithelial cyst, and a recurrent liposarcoma. Mean tumor size was 2.8 cm and mean operative time was 4.8 hours with a mean blood loss of 381 mL. The most common complication was pancreatic leak (5 patients [63%]). Reoperation was necessary in 2 patients (25%), both secondary to hemorrhage. There was no mortality or new-onset diabetes mellitus. One patient transiently required oral pancreatic enzyme supplementation. CONCLUSIONS: Central pancreatectomy may preserve endocrine and exocrine function. While mortality is low, in our experience, central pancreatectomy is associated with a high complication rate. The most common complication is pancreatic leak. Caution is necessary when using central pancreatectomy in the treatment of pancreatic neck lesions. Surgeon experience is of utmost importance in this decision-making process as well as the technical aspects of central pancreatectomy. The precise role of central pancreatectomy in the management of benign or low-malignant potential lesions of the neck of the pancreas remains in evolution.
HYPOTHESIS: Central pancreatectomy has been used sparingly because the spectrum of indications is quite narrow. Although historically used for traumatic pancreatic transection and chronic pancreatitis, it currently is reserved for selective management of pancreatic neck lesions that are benign or have low malignant potential. Varying morbidity rates have been published in the literature. Our objectives were to describe the technique and determine the safety and effectiveness of central pancreatectomy in the excision of benign or low-malignant potential lesions of the pancreatic neck. DESIGN: Retrospective clinicopathologic data review. SETTING: The Mayo Clinic surgical index was used to identify procedures matched for central, median, middle, or middle segment pancreatectomy. PATIENTS: Eight patients (4 men, 4 women) underwent central pancreatectomy between 1998 and 2004. INTERVENTION: Patients with pancreatic neck or proximal body masses underwent central pancreatectomy at the Mayo Clinic, Rochester, Minn. MAIN OUTCOME MEASURES: Patients were followed up closely for postoperative complications during the initial hospital admission. On follow-up, long-term endocrine and exocrine function were determined based on laboratory values and patient history. RESULTS: Abnormalities included 3 islet cell tumors, 2 serous cystadenomas, a mucinous cystadenoma, a lymphoepithelial cyst, and a recurrent liposarcoma. Mean tumor size was 2.8 cm and mean operative time was 4.8 hours with a mean blood loss of 381 mL. The most common complication was pancreatic leak (5 patients [63%]). Reoperation was necessary in 2 patients (25%), both secondary to hemorrhage. There was no mortality or new-onset diabetes mellitus. One patient transiently required oral pancreatic enzyme supplementation. CONCLUSIONS: Central pancreatectomy may preserve endocrine and exocrine function. While mortality is low, in our experience, central pancreatectomy is associated with a high complication rate. The most common complication is pancreatic leak. Caution is necessary when using central pancreatectomy in the treatment of pancreatic neck lesions. Surgeon experience is of utmost importance in this decision-making process as well as the technical aspects of central pancreatectomy. The precise role of central pancreatectomy in the management of benign or low-malignant potential lesions of the neck of the pancreas remains in evolution.
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