Parenchyma-sparing pancreatectomies for benign or border-line tumors of the pancreas

Abstract

Standard pancreatic resections, such as pancreaticoduodenectomy, distal pancreatectomy, or total pancreatectomy, result in an important loss of normal pancreatic parenchyma and may cause impairment of exocrine and endocrine function. Whilst these procedures are mandatory for malignant tumors, they seem to be too extensive for benign or border-line tumors, especially in patients with a long life expectancy. In recent years, there has been a growing interest in parenchyma-sparing pancreatic surgery with the aim of achieving better functional results without compromising oncological radicality in patients with benign, border-line or low-grade malignant tumors. Several limited resections have been introduced for isolated or multiple pancreatic lesions, depending on the location of the tumor: central pancreatectomy, duodenum-preserving pancreatic head resection with or without segmental duodenectomy, inferior head resection, dorsal pancreatectomy, excavation of the pancreatic head, middle-preserving pancreatectomy, and other multiple segmental resections. All these procedures are technically feasible in experienced hands, with very low mortality, although with high morbidity rate when compared to standard procedures. Pancreatic endocrine and exocrine function is better preserved with good quality of life in most of the patients, and tumor recurrence is uncommon. Careful patient selection and expertise in pancreatic surgery are crucial to achieve the best results.

Middle Pancreatectomy - Own Experience

“…However, the past results are satisfactory and comparable with classical surgery. A shorter hospitalization period is observed in case of middle pancreatectomy, and comparable occurrence of complications (33-44%), including pancreatic fistulas (22-33%) (2,30,31).…”

“…Perioperative mortality amounted to 0.7% (0-4%). Mean hospitalization period was 11 days (ranging between 5-30 days) (2). In literature data one may find publications concerning laparoscopic middle pancreatectomy.…”

“…The obtained results correspond to literature data concerning middle pancreatectomy. Sperti (2,32,33).…”

“…Continuous Middle pancreatectomy (central pancreatectomy, median pancreatectomy; middle segment pancreatectomy) consists in the excision of the middle segment of the pancreas. The above-mentioned procedure is performed in case of benign or border-line malignancy tumors located within the isthmus and body of the pancreas, where enucleation is not possible, due to the depth or large size of the lesion (>2 cm) (2,4).…”

“…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)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”