Role of medial pancreatectomy in the management of intraductal papillary mucinous neoplasms and islet cell tumors of the pancreatic neck and body.
OBJECTIVE
Medial pancreatectomy has been applied as a safe and effective alternative in benign diseases located in the pancreatic neck or body. However, the role of this procedure remains controversial. We investigate outcomes using this method in 14 patients.


METHODS
Fourteen consecutive patients underwent medial pancreatectomy. The surgical indications, postoperative outcomes, and pathologic characteristics were retrospectively analyzed.


RESULTS
Among 10 patients with intraductal papillary mucinous neoplasms, 3 patients had minimally invasive adenocarcinoma, and 3 had adenocarcinoma in situ. Four patients required an additional resection of the pancreatic remnant because of a positive surgical margin. A medial pancreatectomy was converted to a distal pancreatectomy in 1 patient with adenocarcinoma in situ. Three patients with islet cell tumor and 1 patient with solid pseudopapillary tumor had no malignant disease. Postoperative complications occurred in 6 patients (43%): 5 had pancreatic fistulas and 1 had a gastric ulcer. All of the patients are doing well without recurrence.


CONCLUSIONS
A medial pancreatectomy is a safe and effective alternative for the treatment of intraductal papillary mucinous neoplasm, islet cell tumor, or solid pseudopapillary tumor located in the neck or body of the pancreas. However, a precise preoperative and intraoperative assessment including an examination of frozen sections is mandatory to select the appropriate surgical procedure.
Shimada
Kazuaki
K
Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Central Hospital, Tokyo, Japan. kshimada@ncc.go.jp
Sakamoto
Yoshihiro
Y
Esaki
Minoru
M
Kosuge
Tomoo
T
Hiraoka
Nobuyoshi
N
D002288:Adenocarcinoma, Mucinous / Q000601:surgery*; D000231:Adenocarcinoma, Papillary / Q000601:surgery*; D007516:Adenoma, Islet Cell / Q000601:surgery*; D000328:Adult; D000368:Aged; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies