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Updated: Jun 27, 2026
Treatment of Middle-segment Pancreatic Benign Tumor Using Laparoscopic Central Pancreatectomy with End-to-end Pancreatic Duct Reconstruction
Published on: January 2, 2026
Middle segment pancreatectomy can be safely incorporated into a pancreatic surgeon's clinical practice
Harish Lavu1, Jamie L Knuth, Marshall S Baker
1Department of Surgery, Division of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.
Abstract:
Middle segment pancreatectomy (MSP) is a new operation where the advantages of parenchymal preservation are counterbalanced by a high postoperative complication rate and unease among surgeons with adopting a new technique. This study reviews our experience incorporating MSP into our clinical practice focusing on the initial 34 consecutive patients operated on by one surgeon at a single institution between 1998 and 2007. Patients were divided into early (initial 17 operations) and late (subsequent 17 operations) groups for analysis. Thirty-one reconstructions were by Roux-en-y pancreaticojejunostomy and three were by pancreaticogastrostomy. Using multiple linear regression and logistic regression, we found no significant differences in performance outcomes (operative time, blood loss, tumor size, margin negative resection rate, pancreatic fistula rate, hospital length of stay, postoperative complications, and hospital readmission rate) between our early and late experience even after adjusting for potential confounding variables (patient demographics, co-morbidities, neoplasm, pancreatitis). The pancreatic fistula rate in this series was 29.4% (10/34) and they were all International Study Group on Pancreatic Fistula (ISGPF) Grade A (60%) or B (40%). In summary, MSP is an operation with a flat learning curve and acceptable morbidity rate that can be safely incorporated as a parenchymal preserving option by pancreatic surgeons in their clinical practice.
Insights
Middle segment pancreatectomy (MSP) is a safe, parenchymal-preserving pancreatic surgery. This study shows MSP has a flat learning curve and acceptable morbidity, making it a viable option for surgeons.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Pancreatic Surgery
Background:
- Middle segment pancreatectomy (MSP) offers parenchymal preservation but presents challenges with surgeon adoption and complication rates.
- Evaluating the learning curve and outcomes of MSP is crucial for its integration into clinical practice.
Purpose of the Study:
- To review the initial experience with 34 consecutive Middle Segment Pancreatectomies (MSP) to assess the learning curve and outcomes.
- To determine if performance outcomes improve after initial experience with MSP.
Main Methods:
- Retrospective review of 34 consecutive MSP patients operated on between 1998 and 2007.
- Patients divided into early (n=17) and late (n=17) groups for comparative analysis using regression models.
- Outcomes assessed included operative time, blood loss, complication rates, and length of stay.
Main Results:
- No significant differences in key performance outcomes were observed between the early and late experience groups.
- The overall pancreatic fistula rate was 29.4% (10/34), with all cases classified as ISGPF Grade A or B.
- Adjustments for confounding variables did not reveal significant differences in outcomes between the groups.
Conclusions:
- Middle segment pancreatectomy (MSP) demonstrates a flat learning curve and acceptable morbidity.
- MSP can be safely incorporated into clinical practice as a parenchymal-preserving pancreatic surgery option.
- Pancreatic surgeons can confidently adopt MSP, benefiting from its parenchymal preservation advantages.
