Middle pancreatectomy: Indications, short- and long-term operative outcomes

Stefano Crippa, Claudio Bassi, Andrew L. Warshaw, Massimo Falconi, Stefano Partelli, Sarah P. Thayer, Paolo Pederzoli, Carlos Fernández Del Castillo

Research output: Contribution to journalArticle

164 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the indications, perioperative, and long-term outcomes of a large cohort of patients who underwent middle pancreatectomy (MP). SUMMARY BACKGROUND DATA: MP is a parenchyma-sparing technique aimed to reduce the risk of postoperative exocrine and endocrine insufficiency. Reported outcomes after MP are conflicting. METHODS: Patients who underwent MP between 1990 and 2005 at the Massachusetts General Hospital and at the University of Verona were identified. The outcomes after MP were compared with a control group that underwent extended left pancreatectomy (ELP) for neoplasms in the mid pancreas. RESULTS: A total of 100 patients underwent MP. The most common indications were neuroendocrine neoplasms, serous cystadenoma, and branch-duct IPMNs. Comparison with 45 ELP showed that intraoperative blood loss and transfusions were significantly higher for ELP. The 2 groups showed no differences in overall morbidity, abdominal complications, overall pancreatic fistula, and grade B/C pancreatic fistula rate (17% in MP and 13% in ELP), but the mean hospital-stay was longer for MP patients (P = 0.005). Mortality was zero. In the MP group, 5 patients affected by IPMNs had positive resection margins and 3 had recurrence. After a median follow-up of 54 months, incidence of new endocrine and exocrine insufficiency were significantly higher in the ELP group (4% vs. 38%, P = 0.0001 and 5% vs. 15.6%, P = 0.039, respectively). CONCLUSIONS: MP is a safe and effective procedure for treatment of benign and low-grade malignant neoplasms of the mid pancreas and is associated with a low risk of development of exocrine and endocrine insufficiency. MP should be avoided in patients affected by main-duct IPMN.

Original languageEnglish (US)
Pages (from-to)69-76
Number of pages8
JournalAnnals of surgery
Volume246
Issue number1
DOIs
StatePublished - Jul 1 2007

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Pancreatectomy
Pancreatic Fistula
Serous Cystadenoma
Pancreatic Neoplasms

ASJC Scopus subject areas

  • Surgery

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Crippa, S., Bassi, C., Warshaw, A. L., Falconi, M., Partelli, S., Thayer, S. P., ... Castillo, C. F. D. (2007). Middle pancreatectomy: Indications, short- and long-term operative outcomes. Annals of surgery, 246(1), 69-76. https://doi.org/10.1097/01.sla.0000262790.51512.57

Middle pancreatectomy : Indications, short- and long-term operative outcomes. / Crippa, Stefano; Bassi, Claudio; Warshaw, Andrew L.; Falconi, Massimo; Partelli, Stefano; Thayer, Sarah P.; Pederzoli, Paolo; Castillo, Carlos Fernández Del.

In: Annals of surgery, Vol. 246, No. 1, 01.07.2007, p. 69-76.

Research output: Contribution to journalArticle

Crippa, S, Bassi, C, Warshaw, AL, Falconi, M, Partelli, S, Thayer, SP, Pederzoli, P & Castillo, CFD 2007, 'Middle pancreatectomy: Indications, short- and long-term operative outcomes', Annals of surgery, vol. 246, no. 1, pp. 69-76. https://doi.org/10.1097/01.sla.0000262790.51512.57
Crippa, Stefano ; Bassi, Claudio ; Warshaw, Andrew L. ; Falconi, Massimo ; Partelli, Stefano ; Thayer, Sarah P. ; Pederzoli, Paolo ; Castillo, Carlos Fernández Del. / Middle pancreatectomy : Indications, short- and long-term operative outcomes. In: Annals of surgery. 2007 ; Vol. 246, No. 1. pp. 69-76.
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