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Central Pancreatectomy for Benign or Low-Grade Malignant Tumors: a Single Center Experience
Elizabeth a. Paulus*, Xiaoyi LI, Alan S. Livingstone, Joe Levi, Danny Yakoub
Surgical Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
BACKGROUND:
Central pancreatectomy is used for select benign and low-grade malignant neoplasms located in the neck and proximal body of the pancreas. There is limited data describing the technique and elucidating the risks and benefits when compared to the standard subtotal pancreatectomy or pylorus preserving pancreaticoduodenectomy.
METHODS:
A single tertiary institutional experience was retrospectively studied from January 2004 to August of 2014. Twenty-seven patients underwent central pancreatectomy (CP), 49 patients distal pancreatectomy (DP), and 20 patients had a pylorus preserving pancreaticoduodenectomy (PPPD) for benign or low-grade malignant lesions located specifically in the neck or proximal body of the pancreas. Primary endpoints included operative time, estimated blood loss and length of hospital stay. Secondary endpoints included postoperative complications such as new onset or worsening of pre-existing diabetes and pancreatic fistula rates.
RESULTS:
Operative time was significantly longer in CP vs DP, yet shorter than PPPD (273.8 ± 59 versus 192.1 ± 41.8 versus 365.5 ± 50.6 minutes, respectively; p<0.001). Median estimated blood loss was significantly more in PPPD compared to CP and DP (250, 100, 100 milliliters, respectively; p=0.02). Median length of stay was 7 days for CP, 6 days for DP and 9.5 days for PPPD. New on-set of diabetes was diagnosed in 1, 3 and 2 patients and worsening of diabetes in 2, 3 and 1 for CP, DP and PPPD respectively (p>0.5). Those who developed new diabetes or worsening of pre-existing diabetes among DP patients tended to be those with more parenchyma resected (not statistically significant). Pancreatic fistula rates were 37% and 40% for CP and PPPD as opposed to only 18% for DP.
CONCLUSIONS:
Central pancreatectomy is a feasible option for certain pancreatic neoplasms situated in the neck or proximal body of the pancreas. The potential benefits of this limited resection are preservation of parenchyma, decreased length of stay compared to PPPD and a trend towards conservation of endocrine function, in addition to allowing for preservation of the spleen. Nonetheless, similar to PPPD, CP has a higher pancreatic leak rate than DP.
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