title: Middle-preserving pancreatectomy: report of two cases and review of the literature.
abstract: BACKGROUND
  Middle-preserving pancreatectomy (MPP) is a parenchyma-sparing surgical procedure which has recently been sporadically reported for the treatment of multicentric periampullary-pancreatic lesions. However, a comprehensive recognition of this procedure has not been clearly elucidated.
  
  
  METHODS
  We herein report two patients undergoing MPP due to synchronous multicentric pancreatic neoplasm. Patient one was a 24-year-old woman with a multicentric solid pseudopapillary neoplasm (SPN) and patient two was a 36-year-old woman with a multicentric serous cystic neoplasm (SCN). Simultaneous atypical pancreaticoduodenectomy and atypical left pancreatectomy were performed in patient one; simultaneous standard pancreaticoduodenectomy and atypical left pancreatectomy with spleen preservation were performed in patient two. Approximately 6 cm and 5 cm segments of the middle portion of the pancreas were preserved, respectively. At follow-up at 36 months and 6 months respectively, patient one had developed diabetes and malabsorption requiring dietary control, exercise and pancreatic enzyme supplement whereas patient two showed normal fasting blood glucose without diarrhea. Both patients were disease-free and in good nutritional condition. We reviewed twenty cases of MPP that were previously reported in the literature. Patient characteristics, surgical techniques and short- and long-term outcomes were analyzed.
  
  
  CONCLUSIONS
  MPP is mainly beneficial for multicentric noninvasive periampullary-pancreatic lesions. However, for multicentric periampullary-pancreatic lesions involving even primary invasive cancers, as long as the invasive cancers affect only one side of the pancreas (proximal or distal), MPP could serve as a rational choice in well-selected patients.
authors.affiliation: Department of General Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197, Ruijin Er Road, Shanghai 200025, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Cheng
authors.forename: Bai-yong
authors.initials: BY
authors.lastname: Shen
authors.forename: Cheng-hong
authors.initials: CH
authors.lastname: Peng
authors.forename: Li-ma
authors.initials: LM
authors.lastname: Na
authors.forename: Dong-feng
authors.initials: DF
authors.lastname: Cheng
mesh_terms: D000328:Adult; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000473:pathology / Q000601:surgery*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012196:Review Literature as Topic; D014057:Tomography, X-Ray Computed; D055815:Young Adult