Abstracts
1997 Digestive Disease Week

Is there a place for central pancreatectomy in pancreatic surgery?

C Iacono, L Bortolasi, G Serio. Department of Surgery, Division of General Surgery C, University of Verona, Italy.

Tumors located in the neck of the pancreas or in its contiguous portions, not so small and superficial to be enucleated, are usually resected with a Whipple procedure or left spleno-pancreatectomy even if benign. Such wide resections have a low operative mortality rate, when performed by experienced surgeons. Nevertheless, such surgery might cause digestive disorders, glucose intollerance, and late post-splenectomy infection. Central pancreatectomy (CP) is a segmentary resection: the cephalic stump is sutured and the distal stump is anastomosed with a Roux-en-Y jejunal loop. The purpose of this study was to evaluate whether CP has a place in pancreatic surgery. Methods Thirteen patients underwent CP. Eleven patients were female, two were male. The mean age was 51 years (range 27-70). The diagnoses were: 5 endocrine tumors (3 insulinomas, 2 non-functioning tumors), 6 serous cystadenomas, 1 mucinous cystadenoma, 1 solid cystic-papillary tumor. Results Mean operative time was 250 minutes (range 210-300); 5 patients (38.4%) needed hemotransfusion (2-3 Units). Mean size of the lesions was 28.6 mm (range 12-50). Postoperative mortality was zero; postoperative course was complicated in 3 patients (23%) (2 low output pancreatic fistulas, lpurulent drainage, lpneumonia with pleural effusion). Mean recovery time was 19 days (range 10-38). At a mean follow up of 68 mos. (range 5-162) patients did not show recurrence of tumors. US Doppler scan showed complete patency of the spleno-mesenteric axis in all cases; no endocrine syndrome was found postoperatively in the 3 patients with insulinoma. Endocrine function was tested in 12 patients with oral glucose tolerance test from 6 months to 7 years after surgery and it was within normal limit in 11 patients; the only patient with preoperative glucose intolerance did not worsen after surgery. Exocrine function evaluated with PancreoLauryl test and fecal fat excretion was normal in all the patients. Conclusion We think that CP has a place in pancreatic surgery; it is a reliable technique for benign or borderline malignant tumors of the pancreatic neck and its contiguous portions. It represents a valid option to major pancreatic resections. In fact, it assures the cure of the tumor with a surgical risk similar to that of standard procedures. The advantages are represented by the preservation of more pancreatic parenchyma, of the anatomy of the upper GI tract, of the biliary tree and the spleen.