Middle pancreatectomy for pancreatic neoplasms

Abstract

Background: A middle pancreatectomy (MP) is a parenchyma-preserving procedure for benign or low-malignant neoplasms in the neck or body of the pancreas that reduces long-term endocrine and exocrine insufficiency. MP requires the handling of 2 (distal and proximal) pancreatic remnants, and therefore, the higher rates of pancreatic fistula and morbidity may occur after MP rather than after standard pancreatectomies, such as for a pancreaticoduodenectomy and distal pancreatectomy. Though there have so far been few reports regarding a high number of series in MP as opposed to standard pancreatic resections, recently reports describing more than 50 case outcomes of MP were published. Methods: A literature search, which examined articles related to MP, was performed using the PubMed database. Data were compiled to generate conglomerate results of mortality and morbidity rates, and the long-term pancreatic functional insufficiency and recurrence after MP. Results: The mortality rates varied from 0 to 3%, and the morbidity from 13 to 62%. The rates of pancreatic fistula in more than 50 cases of MP varied from 8 to 30%. The rates of endocrine and exocrine insufficiency were very low (range, 0-9% and 0-8%, respectively). Conclusions: MP is a safe procedure for the treatment of benign or low-grade malignant neoplasms in the pancreatic neck or body, and in this procedure, the postoperative endocrine and exocrine functions are well preserved. © Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2009.