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Updated: Jul 14, 2026
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Published on: February 9, 2024
Middle pancreatectomy: indications, short- and long-term operative outcomes
Stefano Crippa1, Claudio Bassi, Andrew L Warshaw
1Department of Surgery, Policlinico GB Rossi, University of Verona, Verona, Italy.
Objective:
To evaluate the indications, perioperative, and long-term outcomes of a large cohort of patients who underwent middle pancreatectomy (MP).
Summary Background Data:
MP is a parenchyma-sparing technique aimed to reduce the risk of postoperative exocrine and endocrine insufficiency. Reported outcomes after MP are conflicting.
Methods:
: Patients who underwent MP between 1990 and 2005 at the Massachusetts General Hospital and at the University of Verona were identified. The outcomes after MP were compared with a control group that underwent extended left pancreatectomy (ELP) for neoplasms in the mid pancreas.
Results:
A total of 100 patients underwent MP. The most common indications were neuroendocrine neoplasms, serous cystadenoma, and branch-duct IPMNs. Comparison with 45 ELP showed that intraoperative blood loss and transfusions were significantly higher for ELP. The 2 groups showed no differences in overall morbidity, abdominal complications, overall pancreatic fistula, and grade B/C pancreatic fistula rate (17% in MP and 13% in ELP), but the mean hospital-stay was longer for MP patients (P = 0.005). Mortality was zero. In the MP group, 5 patients affected by IPMNs had positive resection margins and 3 had recurrence. After a median follow-up of 54 months, incidence of new endocrine and exocrine insufficiency were significantly higher in the ELP group (4% vs. 38%, P = 0.0001 and 5% vs. 15.6%, P = 0.039, respectively).
Conclusions:
MP is a safe and effective procedure for treatment of benign and low-grade malignant neoplasms of the mid pancreas and is associated with a low risk of development of exocrine and endocrine insufficiency. MP should be avoided in patients affected by main-duct IPMN.
Insights
Middle pancreatectomy (MP) offers a safe approach for benign and low-grade mid-pancreatic tumors, with lower rates of endocrine and exocrine insufficiency compared to extended left pancreatectomy (ELP). However, MP is not recommended for main-duct intraductal papillary mucinous neoplasms (IPMNs).
Area of Science:
- Surgical Oncology
- Gastroenterology
- Pancreatic Surgery
Background:
- Middle pancreatectomy (MP) is a parenchyma-sparing surgical technique designed to minimize postoperative endocrine and exocrine insufficiency.
- Existing literature presents conflicting outcomes regarding the efficacy and safety of MP.
Purpose of the Study:
- To evaluate the indications, perioperative, and long-term outcomes of a large cohort of patients undergoing middle pancreatectomy (MP).
- To compare the outcomes of MP with extended left pancreatectomy (ELP) for mid-pancreatic neoplasms.
Main Methods:
- A retrospective analysis of patients who underwent MP between 1990 and 2005 at two institutions.
- Comparison of MP outcomes with a control group of 45 patients who underwent ELP for similar indications.
Main Results:
- The most common indications for MP were neuroendocrine neoplasms, serous cystadenoma, and branch-duct intraductal papillary mucinous neoplasms (IPMNs).
- MP demonstrated significantly lower intraoperative blood loss and transfusion requirements compared to ELP.
- While overall morbidity and pancreatic fistula rates were similar, MP patients experienced longer hospital stays. Importantly, long-term follow-up revealed significantly lower rates of new endocrine and exocrine insufficiency in the MP group compared to the ELP group.
Conclusions:
- Middle pancreatectomy is a safe and effective procedure for benign and low-grade malignant neoplasms of the mid pancreas.
- MP is associated with a low risk of developing endocrine and exocrine insufficiency.
- MP should be avoided in patients with main-duct IPMN due to potential for positive margins and recurrence.
