Medial pancreatectomy for tumors of the neck of the pancreas.

Abstract

The surgical treatment of benign tumors of the pancreas usually consists of enucleation or formal pancreatectomy. Nonetheless, enucleation is not always feasible, and extended pancreatectomies may result in impaired endocrine and exocrine function. For these reasons we proposed a limited resection centered on the neck of the pancreas with complete excision of the tumor. The cephalic section was sutured, and a Roux-en-Y jejunal loop was anastomosed to the distal section of the pancreas. Fourteen patients were operated on by this technique. The tumors were mainly cystadenomas (n = 6) and endocrine tumors (n = 4). The other lesions were one epithelial cyst, one necrotic pseudocyst, one Castleman disease, and one cystadenocarcinoma diagnosed after surgery on histologic examination. No patients died. Two patients underwent reoperation: one for a postoperative acute pancreatitis and one for a pancreatic fistula. All patients were followed up from 4 months to 8 years. No patients had exocrine insufficiency or diabetes mellitus. Medial pancreatectomy does not carry a higher operative risk than formal pancreatectomy and avoids extensive pancreatic resection when enucleation is not feasible.