Evaluation of central pancreatectomy and pancreatic enucleation as pancreatic resections--A comparison.
BACKGROUND
For minor pancreatic resection such as enucleation (PE) and central pancreatectomy (CP) comparative data are rare. These techniques provide parenchyma-sparing alternatives to major resections (e.g. pancreaticoduodenectomy) for neuroendocrine tumors, cystic tumors or metastases. This study retrospectively compares the morbidity and mortality of both techniques, with special regard to the formation of postoperative pancreatic fistulas (POPF).


METHODS
Between December 1996 and November 2013 the postoperative events and clinical outcomes of 17 patients after pancreatic enucleation and 26 patients after central pancreatectomy were retrospectively analyzed from a prospectively collected database.


RESULTS
Perioperative mortality was 0% in both groups. There was no significant difference in the overall peri-operative morbidity (CP 80.8% vs. PE 82.4%). The major cause of the high morbidity was the formation of a POPF with 26.9% of the patients after CP and 35.3% after PE. Univariate analysis showed a BMI over 30 kg/m(2) in the CP group to be an independent risk factor. Additional minor complications, e.g. urinary tract infection, pleural effusion, etc. furthermore contributed to the perioperative morbidity.


CONCLUSIONS
PE and central CP are feasible techniques for selected patients, but the indications are limited. Morbidity after these resections is high with the major cause being the development of a POPF.
Department of General, Thoracic and Vascular Surgery, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany. Electronic address: steffen.wolk@uniklinikum-dresden.de.
Steffen
S
Wolk
Department of General, Thoracic and Vascular Surgery, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
Marius
M
Distler
Department of General and Vascular Surgery, RKK Hospital, Sautierstraße 1, Freiburg, Germany.
Stephan
S
Kersting
Department of General, Thoracic and Vascular Surgery, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
Jürgen
J
Weitz
Department of General, Thoracic and Vascular Surgery, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
Hans-Detlev
HD
Saeger
Department of General, Thoracic and Vascular Surgery, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
Robert
R
Grützmann
D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000601:surgery; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D010185:Pancreatic Fistula / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D010195:Pancreatitis / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
Central pancreatectomy; Insulinoma; Pancreatic enucleation; Pancreatic fistula; Pancreatic surgery