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INTRODUCTION: Central pancreatectomy (CP) is an uncommon technique
used to treat select pancreatic pathology. We evaluated the utility and safety of
CP over a 10 year time span at a single institution.
METHODS: Review of prospective database (single surgeon) from 2003-2012.
CP comprised 9% of all pancreatic resections during this period (total of 310).
RESULTS: Thirty patients underwent CP for diagnoses including
neuroendocrine tumor (n=12), cystic neoplasm (n=9) and benign stricture (n=9).
Distal pancreatic continuity was established by pancreaticogastrostomy (n=7),
pancreaticojejunostomy (n=13), dual pancreaticoenterostomy (n=9) or primary
pancreatico-pancreatostomy (n=1). Major complications were limited to 4
patients (13%) who required re-laparotomy or percutaneous drainage. Five
patients (17%) developed postoperative pancreatic fistulae, of which 3 (10%)
were ISGPF grade B/C. There was no peri-operative mortality. At mean follow-up
of 29 months, no patients have developed recurrent tumor. Two patients (7%)
developed diabetes and no patient has exocrine insufficiency. The frequency of
CP has remained constant over the study time period, but patients operated in
the more recent 5-year period were more likely to have more proximal pathology
(pancreatic head) and to undergo dual pancreatic anastomosis (figure)
CONCLUSION: Central pancreatectomy is a safe and valuable option for
management of select proximal pancreatic pathology and is associated with a
low rate of long term endocrine or exocrine insufficiency. Pancreatic fistula and
surgical complication rates are significant but not prohibitive. Novel
reconstruction techniques such as those applied on our series may allow greater
application of this technique to more proximal pancreatic lesions.

Central Pancreatectomy Managed with Dual Pancreatic-Enteric Anastomosis