Four cases of middle segment-preserving pancreatectomy

Abstract

Total pancreatectomy is the useful operative method for multiple pancreatic diseases. However, it induces endocrine and exocrine dysfunctions of the pancreas, resulting in impaired QOL. For this reason, it is important to attempt to preserve as much remnant pancreas as possible. Middle segment-preserving pancreatectomy for multiple pancreatic diseases was performed in 4 cases at our hospital between 2007 and 2013. Case 1 was for ampullary carcinoma and intraductal papillary mucinous neoplasia. Case 2 was for multiple pancreatic metastasis from renal cell carcinoma. Case 3 was for intraductal papillary mucinous carcinoma and pancreatic ductal adenocarcinoma. Case 4 was for multiple intraductal papillary mucinous neoplasms. The length of the postoperative remnant pancreas was 5.2 cm on average. Postoperative pancreatic fistula occurred in two cases. Postoperative diabetes mellitus occurred in two cases and one required insulin treatment. No patient developed exocrine dysfunction and there were no concurrent symptoms of diarrhea or weight loss. Remnant pancreatic metastasis was found 4 years after surgery in Case 2, requiring total remnant pancreatectomy. Case 3 showed recurrence 6 months after surgery. Pancreatectomy with middle segment preservation can conserve more pancreatic functions than total pancreatectomy, resulting in improved postoperative QOL in patients.