Background
Whether patients with focal pancreatic lesions of benign or borderline pathology should
be treated by extended central pancreatectomy rather than by extended classic resectional
procedures, such as extended right and left resections, is controversial.
Methods
Between 1992 and 2007, 105 patients underwent operation for focal pancreatic lesions
of borderline or benign neuroendocrine neoplasms, cystadenoma, intraductal papillary
mucinous neoplasia (IPMN), and secondary metastasis. In all, 35 patients were subjected
to extended central pancreatectomy, whereas the remaining 70 patients were treated
by an extended classic right resection or an extended classic left resection. Groups
were matched according to age, sex, and histopathology.
Results
No peri-operative mortality occurred after extended central pancreatectomy and extended
classic left resection (n = 35, each). Two (6%) patients died after extended classic right resection. Overall,
in-hospital morbidity was 26% after extended central pancreatectomy, 43% after extended
classic right resection, and 37% after extended classic left resection. After a median
follow-up of 48 months, a local recurrence rate of 17% after extended central pancreatectomy
was similar to the corresponding rates of 9% after extended classic left resection
and 14% after extended classic right resection. Endocrine and exocrine impairment
was less pronounced after extended central pancreatectomy (6% and 9%) than after extended
classic left resection (34% and 29%) and extended classic right resection (28% and
24%; P < .05).
Conclusion
Extended central pancreatectomy for appropriate pancreatic neoplasms is associated
with less peri-operative morbidity and mortality than after extended classic left
and extended classic right resection. Long-term local recurrence after extended central
pancreatectomy is similar to the recurrence rates after extended classic right and
classic left resection. Our results suggest that appropriately selected patients will
benefit from extended central pancreatectomy because of the maintenance of endocrine
and exocrine function.
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Article info
Publication history
Published online: December 11, 2009
Accepted:
October 6,
2009
Identification
Copyright
© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
