Abstract
Background and aim
Central pancreatectomy (CP) is an operation that allows one to resect benign or low grade malignant tumours located in the pancreatic isthmus that are not suitable for enucleation. The main advantage of this operation compared with major resections is that it permits to spare normal pancreatic parenchyma.
Patients and methods
The operation is carried out by exposition of the pancreatic neck involved by the lesion. Thereafter, the gland is dissected from the splenic artery and porto-mesenteric axis and divided with a 1 cm clear margin. The cephalic stump is sutured, and the distal stump is anastomosed end-to-end or end-to-side with a Roux-en-Y jejunal loop. We treated 20 patients with this technique. The indications for CP were: serous cystadenoma in seven patients, mucinous in three, solid cystic papillary tumour in one, metastasis from renal cancer in one and endocrine tumour in eight patients.
Results
Mortality rate was 0% and morbidity rate was 35%; pancreatic fistulas occurred in 25% of the cases and were treated conservatively. Results of postoperative endocrine and exocrine function tests were normal in all controlled patients. All the patients are alive without evidence of local recurrence.
Conclusion
CP is a safe technique for benign or low-grade malignant tumours of the pancreatic neck that allows one to cure the tumour with evident functional results without increasing the risk to the patient.
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References
Dagradi A, Serio G (1984) Pancreatectomia intermedia. In: Enciclopedia Medica Italiana, vol XI: pancreas. USES Edizioni Scientifiche, Firenze, pp 850–851
Iacono C, Bortolasi L, Serio G (1998) Is there a place for central pancreatectomy in pancreatic surgery? J Gastrointest Surg 2:509–517
Serio G, Iacono C, Bertrand C, Zicari M, Dagradi A (1987) Trattamento chirurgico di insulinomi della testa e dell’istmo del pancreas. Abstract, 30 Congresso Nazionale S.I.A.Te.C. Verona, 27–29 November 1987
Serio G, Iacono C, Bertrand C, Zicari M, Dagradi A (1987) Trattamento chirurgico di insulinomi della testa e dell’istmo del pancreas. Abstract, VIII Congresso Nazionale Biennale della Sezione Italiana Collegium Internazionale Chirurgiae Digestivae. Monduzzi (ed), Bologna, 1987
Dagradi A, Serio G, Iacono C, Bertrand C (1988) Trattamento chirurgico di insulinomi della testa e dell’istmo pancreatici. Audiovisivo selezionato per il Cinè Clinic. Cineteca Società Italiana di Chirurgia. Congresso Nazionale della Società Italiana di Chirurgia. Rome, October 1988
Serio G, Iacono C, Bertrand C, et al (1987) Trattamento chirurgico di insulinomi della testa e dell’istmo del pancreas. Abstract, XI Congresso Nazionale della Società Italiana di Chirurgia Oncologica (SICO). Monduzzi (ed), Bologna, 1987
Serio G, Iacono C, Trivisone M, et al (1990) Intermediate pancreatectomy. Abstract, 2nd IGSC joint meeting. Hepatogastroenterology 37 [Suppl lI]:A28
Serio G, Iacono C, Modena S, et al (1990) Enucleation and intermediate pancreatectomy in two cases of insulinomas of the pancreas. Abstract, 3rd World Congress of World Association of Hepato-Pancreato-Biliary Surgery. HPB Surg 2 [Suppl]:508
Serio G, Iacono C, Bertrand C, et al (1990) Intermediate pancreatectomy. Abstract, second world week of professional updating in surgery and in surgical and oncological disciplines of the University of Milan. Monduzzi (ed), Bologna, pp 484–485
Serio G, Iacono C, Trivisone M, Dagradi A (1990) Intermediate pancreatectomy. Pancreas 5:730
Serio G, Iacono C, Trivisone M, et al (1991) Resection of benign pancreatic tumor by “intermediate pancreatectomy”. Digestion 49:53
Serio C, Iacono C, Abrescia F, et al (1992) Resection of benign pancreatic tumor by intermediate pancreatectomy. Abstract, World Congress of International Hepato-Biliary-Pancreatic Association. San Diego, Calif, 31 August–2 September 1992
Serio G, Iacono C, Mangiante G, et al (1993) Intermediate pancreatectomy as resection of benign tumors located in the neck of the pancreas. Abstract, European Congress of Hepato-Pancreato-Biliary Association. HBP Surg 6 [Suppl]:329
Serio G, Iacono C, Mangiante G, et al (1993) La pancreatectomia intermedia. Indicazioni, tecnica e risultati funzionali. Abstract, 95 Congresso Nazionale della Società Italiana di Chirurgia. Edizioni Minerva Medica, Turin, 1993
Iacono C, Montresor E, Nifosi F, et al (1994) Central conservative pancreatectomy: indications, technique and functional results. Proceedings of the international meeting on update in the surgical treatment of pancreatic and hepato-biliary tumors. Verona, 26–28 September 1994
Iacono C, Facci E, Falezza G, et al (1994) Intermediate pancreatectomy: indications, technique and functional results. Int J Gastroenterol 26:263–264
Iacono C, Serio G (1995) Central conservative pancreatectomy: indications, technique and functional results in 11 cases. Abstract, Pancreas Club, program 29th annual meeting, San Diego, Calif, 14 May 1995
Iacono C, Facci E, Bortolasi L, et al (1996) Central pancreatectomy. Abstract, Second World Congress of the International Hepato-Pancreato-Biliary Association. HPB Surgery 9 [Suppl 2]:202
Iacono C, Facci E, Bortolasi L, Serio G (1998) Central pancreatectomy: a conservative technique preserving functional pancreatic parenchyma. Hepatogastroenterology 45 [Suppl Il]:CDLXXXIII–CDLXXXIV
Serio G, Iacono C (1998) “La Pancreatectomia Centrale” Cinè Clinic 100th Congresso Nazionale Società Italiana di Chirurgia. Cineteca della Società Italiana di Chirurgia, Rome, 11–16 October 1998
Iacono C, Bortolasi L, Serio G (1999) Central pancreatectomy: a conservative technique preserving functional pancreatic parenchyma. Abstract book, World Congress of Surgery of the International Society of Surgery, Vienna, pp 99
Iacono C, Bortolasi L, Facci E, et al (2000) La pancreatectomia centrale: un intervento ormai codificato per il trattamento di neoplasie benigne e a basso grado di malignità dell’istmo pancreatico. Abstract, XXIV Congresso Nazionale Associazione Italiana Studio del Pancreas, Rome, 27–29 September 2000
Fagniez PL, Kracht M, Rotman N (1988) Limited conservative pancreatectomy for benign tumours: a new technical approach. Br J Surg 75:719
Rotman N, Sastre B, Fagniez P (1993) Medial pancreatectomy for tumors of the neck of the pancreas. Surgery 113:532–535
Asanuma Y, Koyama K, Saito K, Tanaka J (1993) An appraisal of segmental pancreatectomy for benign tumors of the pancreatic body: a report of two cases. Surg Today 23:733–736
Warshaw AL, Rattner DW, Fernandez del Castillo C, Z’graggen K (1998) Middle segment pancreatectomy: a novel technique for conserving pancreatic tissue. Arch Surg 133:327–331
Beger HG, Witte C, Krautzberger W, Bittner (1980) Erfahrung mit einer das Duodenum erhaltenden Pancreaskopfresektion bei chronischer Pankreatitis. Chirurg 51:303–307
Beger HG, Krautzberger W, Gogler H (1981) Résection de la tete du pancréas (pancréatectomie céphalique) avec conservation du duodénum dans les pancréatites chroniques, les tumeures de la tete du pancreas et la compression du canal choledoque. Chirurgie 107:597–604
Beger HG, Krautzberg W, Bittner R, et al (1985) Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery 97:467–473
De Clavière G, Paye F, Fteriche S, et al (2002) Pancreatectomie mediane: resultats d’une serie de 11 patients. Ann Chir 127:48–54
Partensky C, Apa D, Marchal F, et al (1998) Pancreatectomie mediane avec anastomose pancreatogastrique pour neoformation pancreatique. Chirurgie 123:363–367
Ikeda S, Matsumoto S, Maeshiro K, et al (1995) Segmental pancreatectomy for the diagnosis and treatment of small lesions in the neck or body of the pancreas. Hepatogastroenterology 42:730–733
Takeyoshi I, Ohwada S, Nakamura S, et al (1999) Segmental pancreatectomy for mucin-producing pancreatic tumors. Hepatogastroenterology 46:2585–2588
Sperti C, Pasquali C, Ferronato A, et al (2000) Median pancreatectomy for tumors of the neck and body of the pancreas. J Am Coll Surg 190:711–716
Sauvanet A, Partensky C, Sastre B, et al (2000) Medial pancreatectomy: a multi-institutional retrospective study of 53 patients by the French Pancreas Club. Surgery 132:836–843
Christein JD, Kim AW, Golshan MA, et al (2003) Central pancreatectomy for the resection for the benign or low malignant potential neoplasms. World J Surg 27:595–598
Kendall DM, Sutherland D, Najarian JS, et al (1990) Effects of hemipancreatectomy on insulin secretion and glucose tolerance in healthy humans. N Engl J Med 29:898–903
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Iacono, C., Bortolasi, L. & Serio, G. Indications and technique of central pancreatectomy—early and late results. Langenbecks Arch Surg 390, 266–271 (2005). https://doi.org/10.1007/s00423-005-0551-x
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DOI: https://doi.org/10.1007/s00423-005-0551-x