Central pancreatectomy without anastomosis
© Wayne et al; licensee BioMed Central Ltd. 2009
Received: 1 July 2009
Accepted: 31 August 2009
Published: 31 August 2009
Central pancreatectomy has a unique application for lesions in the neck of the pancreas. It preserves the distal pancreas and its endocrine functions. It also preserves the spleen.
This is a retrospective review of 10 patients who underwent central pancreatectomy without pancreatico-enteric anastomosis between October 2005 and May 2009. The surgical indications, operative outcomes, and pathologic findings were analyzed.
All 10 lesions were in the neck of the pancreas and included: 2 branch intraductal papillary mucinous neoplasms (IPMNs), a mucinous cyst, a lymphoid cyst, 5 neuroendocrine tumors, and a clear cell adenoma.
Central pancreatectomy without pancreatico-enteric anastomosis for lesions in the neck and proximal pancreas is a safe and effective procedure. Morbidity is low because there is no anastomosis. Long term endocrine and exocrine function has been maintained.
In 1957, Guillemin and Bessot  described central pancreatectomy (CP) in a patient with chronic pancreatitis. Central pancreatectomy (CP) has since been used in select cases for treating pancreatitis, most often for benign and low grade malignant lesions in the neck of the pancreas [2–4]. Potential advantages of central pancreatectomy include preservation of endocrine, exocrine, and splenic function [3, 5–7].
Benign or low-grade malignant lesions in the neck of the pancreas have been treated surgically, either by pancreaticoduodenectomy resection (PDR) or distal pancreatectomy with splenectomy (DPS) or splenic preserving distal pancreatectomy (SPDP). Each operation involves a resection of a major portion of the pancreas, which in a diseased pancreas can worsen diabetes mellitus and/or exocrine insufficiency [8, 9]. This paper will discuss the technique and benefits of a resection of the central portion of the pancreas; a simplification of the procedure, and a literature review of the topic.
Materials and methods
DM, HTN, obesity
Local wound infection
Mucinous cystic neoplasm
Lymphoid cystic neoplasm
Local wound infection
Local wound seroma
Clear cell adenoma
The resected lesions included a branch IPMN in 2 patients, a mucinous cyst, a lymphoid cyst, five neuroendocrine tumors, and a clear cell adenoma (Table 1). The mean operative time was 73.5 ± 10 minutes, and the estimated blood loss was 164 ± 89 ml. There were no mortalities in the study. The postoperative length of stay (LOS) was 5.9 ± 9.5 days (range 4 to 30); however, this was skewed by one patient with COPD, who had pneumonia postoperatively and was hospitalized for 30 days. The LOS for the other patients in the study was 4.8 ± 0.75 days. Other postoperative complications included a superficial wound infection in 2 patients, and a wound seroma in one patient. These three patients were also obese.
Postoperative Results; Literature Review
Type of pancreatic
Fistula rate (number and percentage)
25 re-operation for bleeding
(CP) n = 13
extended left pancreatectomy
(ELP) n = 18
2/12 had endocrine insufficiency
One patent with gastric emptying
(14% intra-abdominal collection)
No post-op endocrine insufficiency
We suspect the relative frequency of a pancreatic fistula after CP is due to a small pancreatic duct and a normal soft distal gland. These two factors (a small duct and soft parenchyma) account for a higher fistula rate after pancreatico-duodenal resection (PDR). This is our reasoning for omitting a pancreatico-enteric anastomosis during CP. In our experience, the distal pancreatic tissue is usually normal and the duct is small in diameter. The indications for CP in chronic pancreatitis are few since focal pancreatitis confined to the neck of gland is unusual. CP may be technically more difficult because of chronic inflammation in these patients . Furthermore, in patients with a pancreaticogastrostomy, fistula rates aside, exocrine function may not be preserved. Pancreatic enzymes, particularly lipase, are inactivated in an acidic environment [21–23]. Our series of 10 patients supports the value of resection without anastomosis in a short follow up period. To date, none of the patients in the study have developed any endocrine or exocrine deficiencies. So far, the morbidity of a pancreatic leak is removed while exocrine function is preserved in the head and neck and endocrine function remains in both segments of pancreas when using central pancreatectomy without an anastomosis.
CP without an anastomosis may reduce the morbidity and length of hospital stay compared to patients undergoing CP with an anastomosis. It has been shown to be a safe, effective procedure which does not compromise pancreatic function.
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