Middle Pancreatectomy - Own Experience

Abstract

the aim of the study was to analyse early results after middle pancreatectomy based on our experience. Material and methods. During the period between 2008 and 2009, 154 pancreatic resections were performed at the Department of Gastrointestinal Surgery, Silesian Medical University in Katowice. The following procedures were performed: 109 (70.78%) pancreatoduodenectomies, 32 (20.78%) distal pancreatectomies, 9 (5.84%) middle pancreatectomies, 3 (1.94%) total pancreatic resections, and 1 (0.65%) subtotal pancreatic resection. Early results in case of nine middle pancreatectomies were subject to analysis. Results. Average hospitalization period amounted to 24.28 days (ranging between 8 and 57 days). Mean hospitalization period after surgery amounted to 20.71 days (ranging between 6 and 54 days). Average duration of the surgical procedure amounted to 3.6 hours (ranging between 2.25 and 4 hours). Wirsung's duct required drainage in 4 (44.4%) patients. Pancreatoenterostomy was performed in 5 (55.5%) patients. Early postoperative complications were observed in three (33.3%) patients. The most common complications included wound suppuration and intra-abdominal abscess development observed in two (22.2%) patients. Pancreatic fistula development during the postoperative period was observed in case of one (11.1%) patient. Other early postoperative complications included peritoneal cavity hemorrhage (1-11.1%) and pancreatic necrosis (1-11.1%). Two (2.22%) reoperations were required. Early postoperative mortality amounted to 0%. conclusions. Middle pancreatectomy operations performed in experienced centers are considered as safe procedures with a low rate of complications. The most common indication for middle pancreatectomy is the diagnosis of a benign pancreatic tumor. Key words: middle pancreatectomy, middle segment pancreatetomy, central pancreatectomy, median pancreatectomy * This work was supported by the European Community from the European Social Fund within the RFSD 2 project.The most common standard pancreatic resections, such as pancreatoduodenectomy and distal pancreatectomy are burdened with the risk of postoperative exocrine and endocrine pancreatic insufficiency, as well as complications connected with splenectomy (in case of distal resection). The presence of the abovementioned complications is connected with the depletion of the healthy pancreatic parenchyma during these procedures. Therefore, minimally invasive procedures play an increasing role in surgery, sparing the normal pancreatic parenchyma. In case of benign or border-line malignancy tumors middle pancreatectomies are performed more and more often (1-17).

Surgical treatment of pancreatic cystic tumors

“…However, a higher rate of postoperative complications, and primarily of pancreatic fistula (PF), is a disadvantage of this procedure. CP is associated with presence of the so-called "soft pancreas", narrow pancreatic duct, and two pancreatic stumps that require supplying (15)(16)(17)(18)(19)(20)(21). Crippa et al [16] compared CP and extended distal pancreatectomy (EDP) for the treatment of pancreatic tumors, including serous cystadenomas, branch-types IPMNs, and neuroendocrine tumors.…”

Pancreatectomy and Pancreatic Surgery

“…CP generally can be performed as an alternative surgical approach to DP in the treatment of benign or low-grade malignant lesions located in the pancreatic neck and body in order to reduce the loss of parenchyma and therefore postoperative endocrine and exocrine pancreatic failure [9,10]. Thus, CP offers improved endocrine and exocrine longterm results at the expense of a higher risk of postpancreatectomy hemorrhage (PPH) and POPF without increased perioperative mortality [10].…”