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Middle Segmental Pancreatectomy: a Retrospective Study of 76 Cases in a High-Volume-Center in China
Kuirong Jiang*, Zekuan Xu, Zhuyin Qian, Cuncai Dai, Junli Wu, Wentao Gao, Qiang LI, Feng Guo, Jianmin Chen, Jishu Wei, Zipeng Lu, Baobao Cai, Nan Lv, Yi Miao
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Objective: To clarify whether middle segmental pancreatectomy (MSP) is safe and effective for lesions located in the mid-portion of the pancreas.
Background: MSP removes lesions in the neck or body of the pancreas and minimize the parenchyma loss. The perioperative courses and outcomes of the procedure are conflicting.
Methods: Perioperative courses, short-term and follow-up results of patients who underwent MSP between 2004 and 2013 at the the First Affiliated Hospital of Nanjing Medical University were compared to those of a control group of patients who underwent distal pancreatectomy (DP).
Results: An aggregated 76 patients underwent MSP(Female: Male= 48: 28, median age of 52). The main indications included serous cystadenoma (SCN)(n=23), mucinous cystadenoma (MCN)(n=8), pancreatic neuroendocrine tumors (pNETs)(n=18), solid-cystic papillary tumor (SPT)(n=12), and intraductal papillary mucinous neoplasm (IPMN)(n=7). Among them, 3 case were reconstructed as the Omega type of pancreaticojejunostomy, and the rest with closure of the proximal stump plus distal remnant pancreaticojejunostomy. When compared to the cohort of 168 DP, MSP showed no difference in the pre- and post-operative hospital stay and reoperation rate. MSP required longer operation time (MSP: DP=228.6: 186.1 min, p=0.000), and less intraoperative blood loss (MSP: DP=246.7: 392.2 mL, p=0.002). The perioperative motality was zero in both groups. There was no difference in overall morbidity, overall pancreatic fistula (32.9% in MSP and 45.3% in DP), and postpancreatectomy hemorrhage (6.5% in MSP and 2.4% in DP). However MSP demonstrated lower incidence of the International Study Group on Pancreatic Fistula (ISGPF) Grade A (MSP: DP= 1.3%: 11.3%, p= 0.008). After a median follow-up of 21 months, MSP resulted in a lower risk of endocrine insufficiency than that of DP(MSP: DP= 4.3%: 24.7%, p= 0.001) but no significant difference in exocrine failure. None recurrence of the low-grade malignancies, i.e. SPT, IPMN and pNETs, were detected during the follow-up.
Conclusion: MSP is a safe and effective treatment for selected lesions in neck and proximal body of the pancreas with better preserved endocrine function.
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