Indications and technique of central pancreatectomy—early and late results

Abstract

CP is a safe technique for benign or low-grade malignant tumours of the pancreatic neck that allows one to cure the tumour with evident functional results without increasing the risk to the patient.

Tumor sólido-cístico pseudopapilar do pâncreas multicêntrico submetido à gastroduodenopancreatectomia total: relato de caso e revisão da literatura

“…Lesões no corpo ou na cauda têm sido tratadas de preferência, com pancreatectomia distal e preservação esplênica. Para lesões pequenas localizadas no colo pancreático, a pancreatectomia central pode ser opção 7,18 . Para as lesões na região cefálica, tanto a duodenopancreatectomia com preservação pilórica, quanto a gastroduodenopancreatectomia cefálica têm sido as técnicas de eleição.…”

Middle pancreatectomy for selected pancreatic neck tumours

“…2,8,9 In this patient GIA stapler was used to transect the proximal part of the pancreas which fractured the gland. Though, the proximal stump was reinforced by suturing, patient developed grade C pancreatic fistula from the proximal stump which leads to intraabdominal abscess, postpancreatectomy hemorrhage, sepsis and death.…”

Middle Segment Pancreatectomy: A Useful Tool in the Management of Pancreatic Neoplasms

“…In these cases, standard or extended pancreatectomies performed for benign or borderline cases, can result in the loss of a great amount of glandular tissue, significantly increasing the risk of diabetes, impaired exocrine function and splenic loss [1][2][3][4][5][6] . Enucleation would be an adequate alternative for small, benign and low-grade malignant tumours, such as endocrine and cystic neoplasms of the pancreas.…”

“…Unfortunately this conservative procedure is not always applicable. When the neoplastic lesion measures up to 2 cm or more, or is encased within the pancreatic gland, enucleation is associated with a high risk of Wirsung's duct damage; moreover in the case of tumours with uncertain biological behaviour this approach shuld be avoided because of the risk of tumour recurrence [1][2][3][4][5] . Letton and Wilson reported for the first time in the English literature in 1959 two cases of traumatic midpancreatic transection followed by a reconstruction with a Roux-en-Y jejunal loop anastomized to the distal part of the gland 7 .…”

“…Dagradi and Serio, form our own Department of Surgery, were the first in 1984 to propose middle pancreatectomy with an "oncological" indication, treating a pancreatic insulinoma 8 . Subsequently, other Authors reported cases of resection of the middle pancreas, of varying extent, using various terms such as "central pancreatectomy", "middle segment pancreatectomy", "segmental pancreatectomy" and "intermediate pancreatectomy" from chronic pancreatitis to benign, uncertain behaviour or low-grade malignant exocrine and endocrine neoplasms [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . Different tecniques were adopted for gastrointestinal reconstruction including jejunal anastomosis of boh the proximal and distal stump, or of only the distal stump, with pancreaticojejunal or pancreaticogastric anastomosis .…”