title: Reappraisal of central pancreatectomy a 12-year single-center experience.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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 over treated (ie, operated on for benign non evolutive asymptomatic lesions).
  
  
  CONCLUSIONS
  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.
authors.forename: Yvain
authors.initials: Y
authors.lastname: Goudard
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gaujoux
authors.forename: Safi
authors.initials: S
authors.lastname: Dokmak
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cros
authors.forename: Anne
authors.initials: A
authors.lastname: Couvelard
authors.forename: Maxime
authors.initials: M
authors.lastname: Palazzo
authors.forename: Maxime
authors.initials: M
authors.lastname: Ronot
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Vullierme
authors.forename: Philippe
authors.initials: P
authors.lastname: Ruszniewski
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
mesh_terms: D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010180:Pancreatectomy / Q000379:methods / Q000706:statistics & numerical data*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome