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Updated: May 27, 2026
Application of Mid-Pancreatectomy with End-to-End Anastomosis in Pancreatic Benign Tumors
Published on: February 9, 2024
Middle pancreatectomy
Fuyuhiko Motoi1, Shinichi Egawa, Michiaki Unno
1Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan. fmotoi@surg1.med.tohoku.ac.jp
Abstract:
Middle pancreatectomy is parenchyma- and adjacent organ-sparing pancreatectomy indicated for small tumors located in the body, but deeply located in the gland, and therefore hard to enucleate. Others lesions including pancreatic trauma or arteriovenous malformation are also candidate targets. Invasive ductal carcinoma, even when the tumor is small enough, is not eligible because the most of these tumors show extrapancreatic invasion. After exposure of neck to body of the pancreas, middle pancreatectomy was performed by proximal and distal transection, reconstruction after Roux-Y pancreaticojejunostomy, which is the most common. This procedure is low-invasive and allow the preservation of exocrine and endocrine pancreatic function without loss of duodenal passage, however, it also has a high morbidity associated with pancreatic fistula. This article provides indications and surgical techniques with special focus on the procedure of middle pancreatectomy.
Insights
Middle pancreatectomy offers a parenchyma-sparing approach for specific pancreatic body tumors and lesions. While preserving organ function, this surgical technique carries a risk of pancreatic fistula.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Pancreatic Surgery
Background:
- Middle pancreatectomy is a parenchyma- and adjacent organ-sparing procedure.
- It is indicated for small, deeply located tumors in the pancreatic body that are difficult to enucleate.
- Other indications include pancreatic trauma and arteriovenous malformations.
Purpose of the Study:
- To outline the indications and surgical techniques for middle pancreatectomy.
- To highlight the benefits and risks associated with this pancreatic surgery.
Main Methods:
- The procedure involves exposing the pancreas from neck to body.
- Proximal and distal transections are performed.
- Reconstruction is typically achieved via Roux-Y pancreaticojejunostomy.
Main Results:
- Middle pancreatectomy is a low-invasive technique.
- It preserves exocrine and endocrine pancreatic function and duodenal passage.
- A significant risk of pancreatic fistula is associated with this procedure.
Conclusions:
- Middle pancreatectomy is a viable surgical option for select pancreatic body lesions.
- Careful patient selection and surgical technique are crucial.
- Managing the risk of pancreatic fistula is a key consideration post-operatively.
