Abstract
Background. The results of medial pancreatectomy have been previously reported anecdotally. The
purpose of the study was to provide short- and long-term results of MP in a large
multicenter collective series. Methods. From 1990 to 1998, 53 patients (mean age ± SD = 49 ± 15 years) underwent medial pancreatectomy
for primary cystic neoplasms of pancreas (n = 19), endocrine neoplasms (n = 17), intraductal
papillary mucinous neoplasms (IPMN) (n = 6), fibrotic stenosis of the Wirsung's duct
(n = 4), or other benign (n = 4) or malignant (n = 3) diseases. The proximal (right)
pancreatic remnant was sutured (n = 53), and the distal (left) remnant was either
anastomosed to a jejunal loop (n = 26), to the stomach (n = 25), or oversewn (n =
2). Medial pancreatectomy was indicated in 3 patients (6%) because of failed enucleation,
in 3 (6%) to prevent worsening of preexisting diabetes, or to prevent de novo diabetes
in a patient with chronic pancreatitis, and deliberately in the 47 others. Results. The length of the resected pancreas was 5.0± 2.2 cm (range, 2-15). One patient (2%)
died from a pancreatic fistula and portal thrombosis. Three patients were reoperated
on because of complications related to the left pancreas, which was partially or totally
resected. Pancreatic fistula developed in 16 patients (30%). Mean delay for the return
of oral feeding was related to the presence of a pancreatic fistula. At follow-up
(median = 26 months, range, 12-131), 1 pancreatic recurrence and 1 de novo diabetes
occurred in patients without IPMN. In patients with IPMN, the rates of pancreatic
recurrence and diabetes were 40% (2/5), respectively. Conclusions. Medial pancreatectomy effectively preserves long-term endocrine function and is associated
with a low risk of local recurrence, except in patients with IPMN. However, there
is a high risk (30%) of PF after medial pancreatectomy. (Surgery 2002;132:836-43.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Limited conservative pancreatectomy for benign tumours: a new technical approach.Br J Surg. 1988; 75: 719
- Medial pancreatectomy.J Hepatobiliary Pancreat Surg. 2000; 7: 453-455
- Segmental pancreatectomy for the diagnosis and treatment of small lesions of the neck or body of the pancreas.Hepatogastroenterology. 1995; 42: 730-733
- Middle segment pancreatectomy.Arch Surg. 1998; 133: 327-331
- Is there a place for central pancreatectomy in pancreatic surgery?.J Gastrointest Surg. 1998; 2: 509-516
- Medial pancreatectomy for tumors of the neck and body of the pancreas.J Am Coll Surg. 2000; 190: 711-716
- Medial pancreatectomy for tumors of the neck of the pancreas.Surgery. 1993; 113: 532-535
- Simultaneous pancreas-kidney transplantation from live donors.Ann Surg. 1997; 226: 471-482
- Functional and morphological changes in the pancreatic remnant following pancreaticoduodenectomy with pancreaticogastric anastomosis.Br J Surg. 2000; 87: 434-438
- Early and late complications of pylorus-preserving pancreatoduodenectomy in Japan 1998.J Hepatobiliary Pancreat Surg. 1999; 6: 303-311
- Pancréatectomie médiane avec anastomose pancréatogastrique pour néoformation pancréatique.Chirurgie. 1998; 123: 363-367
- Pancréatectomie médiane: résultats d'une série de 11 patients.Ann Chir. 2002; 127: 48-54
- Pancréatite calcifiante chez un tuberculeux rénal: pancréato-jéjunostomie selon une technique originale.Mem Acad Chirurg. 1957; 83: 869-871
- Traumatic severance of pancreas treated by Roux-en-Y anastomosis.Surg Gynecol Obstet. 1959; 109: 473-478
- Limited pancreatectomy: significance of postoperative maintenance of pancreatic exocrine function.J Hepatobiliary Pancreat Surg. 2000; 7: 466-472
- Surgical treatment of intraductal papillary-mucinous tumors of the pancreas.Hepatogastroenterology. 2001; 48: 967-971
- Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy?.Ann Surg. 2000; 232: 419-429
- Rates of complications and death after pancreaticoduodenectomy: risk factors and impact of hospital volume.Ann Surg. 2000; 232: 786-795
- Ten-year experience with 733 pancreatic resections.Arch Surg. 2001; 136: 391-398
- Distal pancreatectomy: indications and outcomes in 235 patients.Ann Surg. 1999; 229: 693-700
- Fibrin glue sandwich prevents pancreatic fistula following distal pancreatectomy.World J Surg. 1998; 22: 494-498
- Randomized clinical trial of ultrasonic dissector or conventional division in distal pancreatectomy for non-fibrotic pancreas.Br J Surg. 1999; 86: 608-611
- A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy.Ann Surg. 1995; 222: 580-588
- Stented versus non-stented pancreaticojejunostomy after pancreaticoduodenectomy.Ann Surg. 1999; 229: 41-48
- Pancreaticoduodenectomy for periampullary adenocarcinoma.J Am Coll Surg. 1994; 179: 545-552
- Surgery for left-sided pancreatic cancer.Br J Surg. 1996; 83: 1065-1070
- Total pancreatectomy for cancer of the pancreas: is it appropriate?.World J Surg. 1996; 20: 288-294
- Postoperative weight gain after standard Whipple's procedure versus pylorus-preserving pancreatoduodenectomy: the influence of tumour status.Br J Surg. 1998; 85: 922-926
- Distal pancreatectomy for trauma: a multicenter experience.J Trauma. 1991; 31: 1600-1606
- Intraductal papillary mucinous tumors of the pancreas: pancreatic resections guided by preoperative morphological assessment and intraoperative extemporaneous examination.Surgery. 2000; 127: 536-544
Article info
Publication history
Accepted:
May 31,
2002
Footnotes
*Reprint requests: Dr Alain Sauvanet, Department of Digestive Surgery, Hôpital Beaujon, AP-HP, University Paris VII, 100 Boulevard du Général Leclerc, 92118 Clichy Cedex, France.
Identification
Copyright
© 2002 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
