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Original Investigation
April 2014

Reappraisal of Central Pancreatectomy: A 12-Year Single-Center Experience

Author Affiliations
  • 1Department of Hepatobiliary and Pancreatic Surgery, Hôpital Beaujon, Assistance Publique–Hôpitaux de Paris, Clichy, France
  • 2Université Paris Diderot, Paris, France
  • 3Centre de Recherche Biomédicale Bichat-Beaujon, Institut National de la Santé et de la Recherche Médicale (INSERM) U773, Paris, France
  • 4Department of Pathology, Hôpital Beaujon, Assistance Publique–Hôpitaux de Paris, Clichy, France
  • 5Department of Gastroenterology, Hôpital Beaujon, Assistance Publique–Hôpitaux de Paris, Clichy, France
  • 6Department of Radiology, Hôpital Beaujon, Assistance Publique–Hôpitaux de Paris, Clichy, France
JAMA Surg. 2014;149(4):356-363. doi:10.1001/jamasurg.2013.4146
Abstract

Importance  Central pancreatectomy, as an alternative to standard resection for benign and low-grade pancreatic neoplasms, has been described in mainly small retrospective series.

Objective  To describe a large single-center experience with central pancreatectomy.

Design, Setting, and Participants  A retrospective case series in a tertiary referral center included 100 consecutive patients undergoing central pancreatectomy with pancreaticogastrostomy from January 1, 2000, to March 1, 2012.

Main Outcomes and Measures  Surgical indications, postoperative morbidity, mortality, and long-term outcomes regarding pancreatic function and recurrence.

Results  Central pancreatectomies were performed mainly for neuroendocrine tumors (35%), intraductal papillary mucinous neoplasms (33%), solid pseudopapillary neoplasms (12%), and mucinous cystadenomas (6%). The postoperative mortality rate was 3% (due to pulmonary embolisms in 2 patients and hemorrhage after pancreatic fistula in 1 patient). Clavien-Dindo III or IV complications occurred in 15% of patients and were due mainly to pancreatic fistula, requiring 10 radiologic drainage procedures, 7 endoscopic procedures, and 6 reoperations overall. After a median follow-up of 36 months, the rates of new-onset exocrine and endocrine insufficiency were 6% and 2%, respectively. Overall, 7 lesions could be considered undertreated, including 3 node-negative R0 microinvasive intraductal papillary mucinous neoplasms (without recurrence at 27, 29, and 34 months) and 4 node-positive neuroendocrine tumors (with 1 hepatic recurrence at 66 months). Among the 25 patients with a doubtful preoperative diagnosis, 9 could be considered overtreated (ie, operated on for benign nonevolutive asymptomatic lesions).

Conclusions and Relevance  Central pancreatectomy is associated with an excellent pancreatic function at the expense of a significant morbidity and a non-nil mortality rate, underestimated by the published literature. The procedure is best indicated for benign or low-grade lesions in young and fit patients who can sustain a significant postoperative morbidity and could benefit from the excellent long-term results.

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