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Updated: Mar 11, 2026
Treatment of Middle-segment Pancreatic Benign Tumor Using Laparoscopic Central Pancreatectomy with End-to-end Pancreatic Duct Reconstruction
Published on: January 2, 2026
Small amounts of tissue preserve pancreatic function: Long-term follow-up study of middle-segment preserving
Zipeng Lu1, Jie Yin, Jishu Wei
1Pancreas Center and Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University Department of Radiology, The First Affiliated Hospital of Nanjing Medical University Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Abstract:
Middle-segment preserving pancreatectomy (MPP) is a novel procedure for treating multifocal lesions of the pancreas while preserving pancreatic function. However, long-term pancreatic function after this procedure remains unclear.The aims of this current study are to investigate short- and long-term outcomes, especially long-term pancreatic endocrine function, after MPP.From September 2011 to December 2015, 7 patients underwent MPP in our institution, and 5 cases with long-term outcomes were further analyzed in a retrospective manner. Percentage of tissue preservation was calculated using computed tomography volumetry. Serum insulin and C-peptide levels after oral glucose challenge were evaluated in 5 patients. Beta-cell secreting function including modified homeostasis model assessment of beta-cell function (HOMA2-beta), area under the curve (AUC) for C-peptide, and C-peptide index were evaluated and compared with those after pancreaticoduodenectomy (PD) and total pancreatectomy. Exocrine function was assessed based on questionnaires.Our case series included 3 women and 2 men, with median age of 50 (37-81) years. Four patients underwent pylorus-preserving PD together with distal pancreatectomy (DP), including 1 with spleen preserved. The remaining patient underwent Beger procedure and spleen-preserving DP. Median operation time and estimated intraoperative blood loss were 330 (250-615) min and 800 (400-5500) mL, respectively. Histological examination revealed 3 cases of metastatic lesion to the pancreas, 1 case of chronic pancreatitis, and 1 neuroendocrine tumor. Major postoperative complications included 3 cases of delayed gastric emptying and 2 cases of postoperative pancreatic fistula. Imaging studies showed that segments representing 18.2% to 39.5% of the pancreas with good blood supply had been preserved. With a median 35.0 months of follow-ups on pancreatic functions, only 1 patient developed new-onset diabetes mellitus of the 4 preoperatively euglycemic patients. Beta-cell function parameters in this group of patients were quite comparable to those after Whipple procedure, and seemed better than those after total pancreatectomy. No symptoms of hypoglycemia were identified in any patient, although half of the patients reported symptoms of exocrine insufficiency.In conclusion, MPP is a feasible and effective procedure for middle-segment sparing multicentric lesions in the pancreas, and patients exhibit satisfied endocrine function after surgery.
Insights
Middle-segment preserving pancreatectomy (MPP) offers a viable surgical option for multifocal pancreatic lesions, maintaining endocrine function. Long-term outcomes show preserved beta-cell function, comparable to other pancreatic procedures.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Endocrinology
Background:
- Middle-segment preserving pancreatectomy (MPP) is a novel surgical technique for multifocal pancreatic lesions.
- Long-term pancreatic function after MPP remains incompletely understood.
Purpose of the Study:
- To evaluate short- and long-term outcomes of MPP.
- Specifically, to assess long-term pancreatic endocrine function following the procedure.
Main Methods:
- Retrospective analysis of 5 patients who underwent MPP between 2011 and 2015.
- Computed tomography volumetry for tissue preservation assessment.
- Oral glucose challenge tests and hormonal assays (insulin, C-peptide) to evaluate beta-cell function.
- Comparison with pancreaticoduodenectomy (PD) and total pancreatectomy outcomes.
Main Results:
- Median follow-up of 35 months revealed only 1 new-onset diabetes mellitus case among 4 pre-euglycemic patients.
- Beta-cell function parameters were comparable to PD and superior to total pancreatectomy.
- Half of the patients reported exocrine insufficiency symptoms, with no hypoglycemia observed.
Conclusions:
- MPP is a feasible and effective procedure for treating middle-segment multifocal pancreatic lesions.
- Patients undergoing MPP demonstrate satisfactory long-term endocrine function preservation.
