Middle Pancreatectomy With Pancreaticogastrostomy: A Technique, Operative Outcomes, and Long-Term Pancreatic Function

作者：Sudo Takeshi^*; Murakami Yoshiaki; Uemura Kenichiro; Hayashidani Yasuo; Hashimoto Yasushi; Ohge Hiroki; Sueda Taijiro

来源：Journal of Surgical Oncology, 2010, 101(1): 61-65.

DOI：10.1002/jso.21430

• middle pancreatectomy
• pancreaticogastrostomy
• pancreatic fistula
• pancreatic endocrine and exocrine function

Background and Objectives: Middle pancreatectomy is infrequently performed in selected patients. The rationale is to preserve pancreatic function. This study evaluates a technique, operative outcomes, and long-term exocrine and endocrine pancreatic function of the middle pancreatectomy procedure.
Methods: Nineteen patients who underwent middle pancreatectomy between 1996 and 2008 were reviewed. Indications included eight intraductal papillary-mucinous neoplasms, five endocrine tumors, one serous and two mucinous cystadenomas, and three other benign lesions. Reconstruction of the distal pancreatic remnant was performed with pancreaticogastrostomy using the duct-to-mucosa method in 16 patients and with Roux-en-Y end-to-end pancreaticojejunostomy in 3 patients.
Results: Median operative time was 215 ruin. Perioperative mortality was nil. Morbidity was 53%, including 9 (47%) pancreatic fistulas. One patient with hemorrhage, complicated by a pancreatic fistula was successfully treated by endovascular embolization. No patients required postsurgical reoperation. Only one patient had clinical exocrine insufficiency requiring pancreatic enzyme supplementation. None developed postresection new-onset insulin-dependent diabetes.
Conclusions: Middle pancreatectomy with pancreaticogastrostomy is feasible and reasonable technique. Although the incidence of pancreatic fistula formation may still be higher compared to conventional resection, long-term exocrine, and endocrine pancreatic function may be preserved. Thus, careful patient selection and experienced pancreatic surgeons in high-volume centers are of great importance. J. Surg. Oncol. 2010;101:61-65.

• 出版日期2010-1-1