Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 7, 2013; 19(9): 1458-1465
Published online Mar 7, 2013. doi: 10.3748/wjg.v19.i9.1458
Middle segmental pancreatectomy: A safe and organ-preserving option for benign and low-grade malignant lesions
Zhi-Yong Du, Shi Chen, Bao-San Han, Bai-Yong Shen, Ying-Bing Liu, Cheng-Hong Peng
Zhi-Yong Du, Ying-Bing Liu, Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
Zhi-Yong Du, Shi Chen, Bao-San Han, Bai-Yong Shen, Cheng-Hong Peng, Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Shi Chen, Department of Hepatobiliary Surgery, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
Author contributions: Chen S, Shen BY and Peng CH performed the clinical surgery; Du ZY, Chen S and Peng CH designed the research; Du ZY, Chen S and Han BS collected and analyzed data; Du ZY and Chen S wrote the manuscript; and Liu YB and Peng CH revised and finally approved the article to be published.
Supported by The Ministry of Health Sector Funds of China, No. 201002020
Correspondence to: Cheng-Hong Peng, MD, FACS, Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China. chhpeng@188.com
Telephone: +86-21-64370045 Fax: +86-523-87636908
Received: October 30, 2012
Revised: December 31, 2012
Accepted: January 11, 2013
Published online: March 7, 2013
Processing time: 132 Days and 19.1 Hours
Abstract

AIM: To study the feasibility and safety of middle segmental pancreatectomy (MSP) compared with pancreaticoduodenectomy (PD) and extended distal pancreatectomy (EDP).

METHODS: We studied retrospectively 36 cases that underwent MSP, 44 patients who underwent PD, and 26 who underwent EDP with benign or low-grade malignant lesions in the mid-portion of the pancreas, between April 2003 and December 2009 in Ruijin Hospital. The perioperative outcomes and long-term outcomes of MSP were compared with those of EDP and PD. Perioperative outcomes included operative time, intraoperative hemorrhage, transfusion, pancreatic fistula, intra-abdominal abscess/infection, postoperative bleeding, reoperation, mortality, and postoperative hospital time. Long-term outcomes, including tumor recurrence, new-onset diabetes mellitus (DM), and pancreatic exocrine insufficiency, were evaluated.

RESULTS: Intraoperative hemorrhage was 316.1 ± 309.6, 852.2 ± 877.8 and 526.9 ± 414.5 mL for the MSP, PD and EDP groups, respectively (P < 0.05). The mean postoperative daily fasting blood glucose level was significantly lower in the MSP group than in the EDP group (6.3 ± 1.5 mmol/L vs 7.3 ± 1.5 mmol/L, P < 0.05). The rate of pancreatic fistula was higher in the MSP group than in the PD group (42% vs 20.5%, P = 0.039), all of the fistulas after MSP corresponded to grade A (9/15) or B (6/15) and were sealed following conservative treatment. There was no significant difference in the mean postoperative hospital stay between the MSP group and the other two groups. After a mean follow-up of 44 mo, no tumor recurrences were found, only one patient (2.8%) in the MSP group vs five (21.7%) in the EDP group developed new-onset insulin-dependent DM postoperatively (P = 0.029). Moreover, significantly fewer patients in the MSP group than in the PD (0% vs 33.3%, P < 0.001) and EDP (0% vs 21.7%, P = 0.007) required enzyme substitution.

CONCLUSION: MSP is a safe and organ-preserving option for benign or low-grade malignant lesions in the neck and proximal body of the pancreas.

Keywords: Middle segmental pancreatectomy; Pancreaticoduodenectomy; Extended distal pancreatectomy; Pancreatic fistula; Pancreatic endocrine function; Pancreatic exocrine function