Central pancreatectomy with pancreaticogastrostomy for benign pancreatic pathology

Abstract

Benign lesions of the neck and proximal body of the pancreas pose an interesting surgical challenge. If the lesions are not amenable to simple enucleation, surgeons may be faced with the choice of performing a right-sided resection (pancreaticoduodenectomy) or a left-sided resection (distal pancreatectomy) to include the lesion, resulting in resection of a substantial amount of normal pancreatic parenchyma. Central pancreatic resection has been reported with Roux-en-Y pancreaticojejunostomy reconstruction; however, this interrupts small bowel continuity and obligates an additional anastomosis. We have reviewed our experience with central pancreatectomy with pancreaticogastrostomy (PG) for benign central pancreatic pathology. Between January 1999 and December 2002, 14 central pancreatectomies were performed with PG reconstruction. There were 7 women and 7 men with a mean age of 60.9 years. Five resections were performed for islet cell tumors, three were performed for noninvasive intraductal papillary mucinous neoplasms, two were performed for serous cystadenoma, and one each was performed for a simple cyst, pseudocyst, mucinous metaplasia, and focal chronic pancreatitis. Seven out of 14 patients experienced a total of 10 complications. Pancreatic fistulae manifested by drainage of amylase-rich fluid from the operatively placed drains developed in 5 patients (36%). Reoperation or interventional radiologic procedures were not required in any patient with a fistula. Postoperative follow-up demonstrated 13 out of 14 patients to be alive and well without evidence of pancreatic insufficiency. One patient died at home on postoperative day 57 of cardiac pathology. Central pancreatectomy with PG is a safe and effective procedure that allows for preservation of pancreatic endocrine and exocrine function without disruption of enteric continuity. The complication of pancreatic fistula was managed conservatively via maintenance of operatively placed drains.