Middle pancreatectomy for pancreatic neoplasms

Area of Science:

• Surgical Oncology
• Gastroenterology
• Pancreatic Surgery

Background:

• Middle pancreatectomy (MP) is a parenchyma-preserving surgery for pancreatic neck/body neoplasms.
• It aims to reduce long-term endocrine and exocrine insufficiency.
• MP involves managing two pancreatic remnants, potentially increasing fistula and morbidity risks compared to standard resections.

Purpose of the Study:

• To evaluate the safety and outcomes of middle pancreatectomy (MP).
• To assess mortality, morbidity, and long-term functional outcomes after MP.
• To analyze recurrence rates following MP for pancreatic neoplasms.

Main Methods:

• A literature search was conducted using the PubMed database for articles on MP.
• Data on mortality, morbidity, pancreatic fistula, endocrine/exocrine insufficiency, and recurrence were compiled.
• Analysis focused on studies reporting outcomes for over 50 cases of MP.

Main Results:

• Mortality rates ranged from 0-3%; morbidity rates varied from 13-62%.
• Pancreatic fistula rates in series >50 cases were 8-30%.
• Rates of endocrine and exocrine insufficiency were low (0-9% and 0-8%, respectively).

Conclusions:

• Middle pancreatectomy is a safe and effective procedure for benign or low-grade malignant pancreatic neoplasms.
• The procedure effectively preserves postoperative endocrine and exocrine functions.
• MP offers a viable parenchyma-preserving option with favorable functional outcomes.