Reappraisal of Central Pancreatectomy

Abstract

Central pancreatectomy is associated with an excellent pancreatic function at the expense of a significant morbidity and a non-nil mortality rate,underestimated by the published literature. The procedure is best indicated for benign or low-grade lesions in young and fit patients who can sustain a significant postoperative morbidity and could benefit from the excellent long-term results.

Central pancreatectomy for the treatment of a benign pancreatic lesion. Case report and literature review

“…The high level of complexity of this technique should be noted, as well as the probable higher rate of pancreatic fistula during the postoperative period (1,3,5).…”

“…When it comes to dealing with benign lesions of the isthmus and proximal body of the pancreas which cannot be treated with enucleation (large lesions or lesions close to the duct of Wirsung), the usual techniques performed are a distal pancreatectomy (DP) or central pancreatectomy (CP) (3)(4)(5). The classic approach with DP involves the complete resection of the body and tail of the pancreas; however, CP allows the preservation of the distal pancreas, without the need of a splenectomy.…”

“…Central pancreatectomy seems to reduce the intraoperative blood loss, but it is associated with an increase in the surgery time which is related to the meticulousness required in this type of procedure (1,3,9).…”

“…According to the meta-analysis performed by Iacono et al in 2013, the risk of endocrine insufficiency in CP was 5.5% versus 23.6% in the case of DP. With regard to exocrine function, the percentage would be 11.9% versus 19.1% (1,3). On a national level, the study performed by Herrera-Cabezón et al should be mentioned, which reviews 480 pancreatic resections, among them ten CP.…”

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

“…Data from the literature have shown that overall morbidity after CP ranges from 29 to 92% and the POPF rate ranges from 7.5 to 100% [4, 18-26]. Different assessments and definitions of POPF may explain such a large range of rates of POPF after CP or DP.…”