Is Central Pancreatectomy Truly Recommendable? A 9-Year Single-Center Experience

Abstract

Aims: To compare the short- and long-term outcomes in patients with pancreatic benign or borderline neoplasm who underwent central pancreatectomy (CP) and distal pancreatectomy (DP). Methods: The inclusion criteria were as follows: (1) single benign or low-grade malignant tumor; (2) tumor confined to the pancreatic neck or proximal body; and (3) tumor amenable to either CP or DP. Short and long-term outcomes, including complications, pancreatic exocrine and endocrine function, and quality of life (QoL) were analyzed retrospectively. Results: Sixteen patients who underwent CP and 26 patients who underwent DP were included. The median follow-up period was 53 months (range 21–117 months). Patients undergoing CP were significantly more likely to experience complications (68.7 vs. 23%, p = 0.003) especially grade B/C postoperative pancreatic fistula (62.5 vs. 23%, p = 0.011) than those undergoing DP. During the long-term follow-up, 2 patients in the DP group developed new-onset diabetes mellitus, but no patient in CP group developed this condition (8 vs. 0%, p = 0.382). Evidence of exocrine insufficiency, including severe diarrhea or steatorrhea, was not observed in either group. Both groups were equally satisfied with the overall health status and overall QoL. Conclusion: CP is associated with excellent pancreatic function but a significantly increased postoperative morbidity and risk compared to DP. Therefore, the indication of CP should be chosen strictly.

Clinical efficacy of middle pancreatectomy contrasts distal pancreatectomy: a single‐institution experience and review of literature

“…Literature review identified 2685 articles. Finally, 14 articles were included in our study . A total of 1104 patients were contained in this research, consisting of 432 patients undergoing MP and 672 patients undergoing DP.…”

“…Malignant pancreatic tumours are usually considered to spread lymphatic and venous drainage area around the tail of pancreas and the splenic hilum. Due to the incomplete dissection of soft tissue and nodes, MP cannot provide adequate tissue resection for cancers . Therefore, MP is just suitable for benign and low‐malignant potential conditions in pancreatic carcinoma, and also in mucinous cystic neoplasms, solid pseudo papillary neoplasms, intra‐ductal papillary mucinous neoplasms and other benign lesions …”

Laparoscopic spleen-preserving distal versus central pancreatectomy for tumors in the pancreatic neck and proximal body

“…This study investigated that the overall complications incidence was significantly higher in LCP group than LSPDP group (35 vs 6%, P = .004). Lv et al [27] reported that overall complications rate of traditional CP was higher as compared with outcomes following DP (68.7 vs 23%, P = .003). It was also indicated that the overall complications rate of LCP and LSPDP groups in this study was lower than traditional CP and DP reported in literature, [20,27,28] that might attribute to the fact that laparoscopic surgery was more accurate and with less tissue injured.…”

“…As for the reasons that LCP associates with higher POPF rate, on the one hand, the pancreatic stump in LCP (with 2 stumps) is more than LSPDP (with 1 stump), [27] whereas on the other one hand, the main pancreatic duct of distal pancreatic stump surface is exposed and anastomosed to the jejunum in LCP (the pancreatic duct is much smaller closer to the tail side of pancreas, duct to mucosa pancreaticojejunostomy is difficult); however, the main pancreatic duct of pancreatic stump surface is closed by surgical stapler in LSPDP, theoretically. In addition, because of the pancreaticojejunostomy in LCP, the intestinal juice is mixed with pancreatic juice, pancreatic enzyme is vulnerable to activated by intestinal juice, and the POPF may become more severe.…”

“…The definition of endocrine and exocrine insufficiency was lack of unified standard in literatures. [2,7,27] In this study, we focused on the quality of life after operation, used whether needing postoperative pancreatin and insulin treatment to evaluate endocrine and exocrine pancreatic functions. The results suggested that the proportion of postoperative pancreatin and insulin treatment in LCP group were similar to LSPDP group (pancreatin: 9% vs 17%, P = .383; insulin: 0 vs 3%, P = 1.000, respectively).…”