Better preservation of endocrine function after central versus distal pancreatectomy for mid-gland lesions

Surgery. 2010 Dec;148(6):1247-54; discussion 1254-6. doi: 10.1016/j.surg.2010.09.003.


Background: Traditional resections for benign and low-grade malignant neoplasms of the mid pancreas result in loss of normal parenchyma that can cause pancreatic endocrine and exocrine insufficiency. Central pancreatectomy (CP) is a parenchyma-sparing option for such lesions. This study evaluates a single institution's experience with CP and compares outcomes with distal pancreatectomy (DP).

Methods: We retrospectively collected data on CP patients from 1997 through 2009 and evaluated outcomes. In a subset of 50 patients, we performed a matched-pairs analysis to directly compare the short- and long-term outcomes of CP and DP.

Results: Seventy-three patients underwent CP with a median operating room time of 254 minutes. Overall morbidity was 41.1% with pancreatic fistula in 20.5%. Mortality was 0%. There were no differences in fistula, morbidity, and mortality rates between the CP and DP groups. The CP group had resected for smaller lesions. CP patients had a lower rate of new-onset and worsening diabetes than DP patients (14% vs 46%; P = .003). Of new-onset and worsening diabetics, only 1 CP patient required insulin compared with 14 DP patients (P = .002).

Conclusion: CP is safe and effective for select neoplasms of the mid pancreas. Patients undergoing CP have markedly decreased insulin requirements compared with DP patients.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cysts / surgery
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / etiology
  • Disease Progression
  • Drainage / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • Pancreatectomy / methods*
  • Pancreatectomy / standards
  • Pancreatic Diseases / surgery*
  • Pancreatic Fistula / surgery*
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / surgery
  • Postoperative Complications / classification
  • Postoperative Complications / therapy
  • Racial Groups
  • Retrospective Studies
  • Safety
  • Sepsis / epidemiology
  • Treatment Outcome