Better preservation of endocrine function after central versus distal pancreatectomy for mid-gland lesions.
BACKGROUND
Traditional resections for benign and low-grade malignant neoplasms of the mid pancreas result in loss of normal parenchyma that can cause pancreatic endocrine and exocrine insufficiency. Central pancreatectomy (CP) is a parenchyma-sparing option for such lesions. This study evaluates a single institution's experience with CP and compares outcomes with distal pancreatectomy (DP).


METHODS
We retrospectively collected data on CP patients from 1997 through 2009 and evaluated outcomes. In a subset of 50 patients, we performed a matched-pairs analysis to directly compare the short- and long-term outcomes of CP and DP.


RESULTS
Seventy-three patients underwent CP with a median operating room time of 254 minutes. Overall morbidity was 41.1% with pancreatic fistula in 20.5%. Mortality was 0%. There were no differences in fistula, morbidity, and mortality rates between the CP and DP groups. The CP group had resected for smaller lesions. CP patients had a lower rate of new-onset and worsening diabetes than DP patients (14% vs 46%; P = .003). Of new-onset and worsening diabetics, only 1 CP patient required insulin compared with 14 DP patients (P = .002).


CONCLUSIONS
CP is safe and effective for select neoplasms of the mid pancreas. Patients undergoing CP have markedly decreased insulin requirements compared with DP patients.
Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
Joseph
J
DiNorcia
Leaque
L
Ahmed
Minna K
MK
Lee
Patrick L
PL
Reavey
Elizabeth A
EA
Yakaitis
James A
JA
Lee
Beth A
BA
Schrope
John A
JA
Chabot
John D
JD
Allendorf
D003560:Cysts / Q000601:surgery; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology; D018450:Disease Progression; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy / Q000379:methods* / Q000592:standards; D010182:Pancreatic Diseases / Q000601:surgery*; D010185:Pancreatic Fistula / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000145:classification / Q000628:therapy; D044469:Racial Groups; D012189:Retrospective Studies; D012449:Safety; D018805:Sepsis / Q000453:epidemiology; D016896:Treatment Outcome