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Middle pancreatectomy with pancreaticogastrostomy: A technique, operative outcomes, and long‐term pancreatic function
Author(s) -
Sudo Takeshi,
Murakami Yoshiaki,
Uemura Kenichiro,
Hayashidani Yasuo,
Hashimoto Yasushi,
Ohge Hiroki,
Sueda Taijiro
Publication year - 2009
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21430
Subject(s) - medicine , pancreatic fistula , pancreatectomy , pancreas , mucinous cystadenoma , surgery , perioperative , pancreatic duct , endocrine system , serous fluid , hormone
Background and Objectives Middle pancreatectomy is infrequently performed in selected patients. The rationale is to preserve pancreatic function. This study evaluates a technique, operative outcomes, and long‐term exocrine and endocrine pancreatic function of the middle pancreatectomy procedure. Methods Nineteen patients who underwent middle pancreatectomy between 1996 and 2008 were reviewed. Indications included eight intraductal papillary‐mucinous neoplasms, five endocrine tumors, one serous and two mucinous cystadenomas, and three other benign lesions. Reconstruction of the distal pancreatic remnant was performed with pancreaticogastrostomy using the duct‐to‐mucosa method in 16 patients and with Roux‐en‐Y end‐to‐end pancreaticojejunostomy in 3 patients. Results Median operative time was 215 min. Perioperative mortality was nil. Morbidity was 53%, including 9 (47%) pancreatic fistulas. One patient with hemorrhage, complicated by a pancreatic fistula was successfully treated by endovascular embolization. No patients required postsurgical reoperation. Only one patient had clinical exocrine insufficiency requiring pancreatic enzyme supplementation. None developed postresection new‐onset insulin‐dependent diabetes. Conclusions Middle pancreatectomy with pancreaticogastrostomy is feasible and reasonable technique. Although the incidence of pancreatic fistula formation may still be higher compared to conventional resection, long‐term exocrine, and endocrine pancreatic function may be preserved. Thus, careful patient selection and experienced pancreatic surgeons in high‐volume centers are of great importance. J. Surg. Oncol. 2010;101:61–65. © 2009 Wiley‐Liss, Inc.