Median pancreatectomy for tumors of the neck and body of the pancreas

Background: When enucleation is too risky because of possible damage of the main pancreatic duct, benign tumors located in the neck or body of the pan creas are usually removed by a left (spleno)-pancreatectomy or by a pancrea toduodenectomy. But standard pancreatic resection results in an important l oss of normal pancreatic parenchyma and may cause impairment of exocrine an d endocrine function. The aim of this study was to evaluate early and longt erm results of median pancreatectomy, a limited resection of the midportion of the pancreas, in selected patients with benign or borderline tumors of the pancreas. Study Design: Records of patients at Ospedale Busonera between November 198 5 and September 1998 were reviewed. Ten patients with tumors of the neck or body of the pancreas underwent median pancreatectomy; the cephalic stump w as sutured and the distal stump was anastomosed with a Roux-en-Y jejunal lo op. Follow-up included clinical evaluation and routine laboratory tests: ab dominal ultrasonography, exocrine and endocrine pancreatic function with fe cal chymotrypsin, and an oral glucose tolerance test. Results: Pathologic examination showed: insulinoma (n = 3), mucinous cystad enoma (n = 3), nonfunctioning endocrine tumor (n = 1), papillary-cystic neo plasm (n = 1), serous cystadenoma (n = 1), and intraductal mucinous tumor ( n = 1). Operative mortality and morbidity were 0% and 40%, respectively; pa ncreatic fistula occurred in three patients. At mean followup of 62.7 month s, no recurrence was found and no patient had exocrine insufficiency or glu cose metabolism impairment. Conclusions: Median pancreatectomy is a safe and effective alternative to m ajor pancreatic resection in selected patients with benign or low-malignant lesions of the pancreas. This procedure carries a surgical risk similar to that of the standard operation, but avoids extensive pancreatic resection and pancreatic function impairment. (J Am Coll Surg 2000;190:711-716. (C) 2 000 by the American College of Surgeons).