Skip to main content

Advertisement

SpringerLink
Log in

Central Pancreatectomy Versus Distal Pancreatectomy and Pancreaticoduodenectomy for Benign and Low-Grade Malignant Neoplasms: A Retrospective and Propensity Score-Matched Study with Long-Term Functional Outcomes and Pancreas Volumetry

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

It remains controversial whether central pancreatectomy (CP) can preserve the exocrine and endocrine function of the pancreas or not. This study aimed to evaluate the safety and efficacy of CP compared with distal pancreatectomy (DP) and pancreaticoduodenectomy (PD) for benign and low-grade malignant neoplasms.

Methods

This retrospective study enrolled 219 patients who underwent elective CP (n = 55), DP (n = 70), or PD (n = 94) for benign and low-malignant neoplasms in a single university hospital between January 2000 and December 2015. Patients who underwent CP were propensity score matched to patients who underwent DP or PD at a 1:1 ratio, respectively. Peri- and postoperative outcomes, long-term endocrine/exocrine function, and pancreatic volume change 12 months postoperatively were prospectively evaluated.

Results

Of the 165 patients, 55 were included in each of the CP, DP, and PD groups. Significant differences between the CP and DP groups were observed in overall morbidity (CP: n = 18, 33% vs DP: n = 8, 14%; P = 0.041), clinically relevant postoperative pancreatic fistula (CP: n = 13, 24% vs DP: n = 4, 7%; P = 0.022), stool elastase level 12 months after surgery (CP: 151 μg/g vs DP: 245 μg/g; P = 0.003), and percentage change in the remnant pancreatic volume 12 months after surgery (CP: − 9.4% vs DP: + 7.5%; P < 0.001).

Conclusions

The indications for CP to treat benign and low-grade malignant pancreatic neoplasms should be limited to cases in which the distal pancreatic volume can be considerably saved and PD can be prevented because CP has a higher postoperative morbidity without a marked functional superiority over DP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Leonard D, Baulieux J, Rode A, et al. Multiple synchronous serous cystadenomas of the pancreas: uncommon CT and MRI findings. J Hepatobiliary Pancreat Surg. 2007;14:600–3.

    Article  Google Scholar 

  2. Kawai M, Uchiyama K, Tani M, et al. Clinicopathological features of malignant intraductal papillary mucinous tumors of the pancreas: the differential diagnosis from benign entities. Arch Surg. 2004;139:188–92.

    Article  Google Scholar 

  3. Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg. 1999;229:693–8.

    Article  CAS  Google Scholar 

  4. King J, Kazanjian K, Matsumoto J, et al. Distal pancreatectomy: incidence of postoperative diabetes. J Gastrointest Surg. 2008;12:1548–53.

    Article  Google Scholar 

  5. Efron DT, Lillemoe KD, Cameron JL, Yeo CJ. Central pancreatectomy with pancreaticogastrostomy for benign pancreatic pathology. J Gastrointest Surg. 2004;8:532–8.

    Article  Google Scholar 

  6. Roggin KK, Rudloff U, Blumgart LH, Brennan MF. Central pancreatectomy revisited. J Gastrointest Surg. 2006;10:804–12.

    Article  Google Scholar 

  7. Iacono C, Bortolasi L, Serio G. Indications and technique of central pancreatectomy: early and late results. Langenbecks Arch Surg. 2005;390:266–71.

    Article  Google Scholar 

  8. Paiella S, De Pastena M, Faustini F, et al. Central pancreatectomy for benign or low-grade malignant pancreatic lesions: a single-center retrospective analysis of 116 cases. Eur J Surg Oncol. 2019;45:788–92.

    Article  Google Scholar 

  9. Xiao W, Zhu J, Peng L, Hong L, Sun G, Li Y. The role of central pancreatectomy in pancreatic surgery: a systematic review and meta-analysis. HPB Oxford. 2018;20:896–904.

    Article  Google Scholar 

  10. Crippa S, Bassi C, Warshaw AL, et al. Middle pancreatectomy: indications, short- and long-term operative outcomes. Ann Surg. 2007;246:69–76.

    Article  Google Scholar 

  11. Muller MW, Friess H, Kleeff J, et al. Middle segmental pancreatic resection: an option to treat benign pancreatic body lesions. Ann Surg. 2006;244:909–18.

    Article  Google Scholar 

  12. Hutchins RR, Hart RS, Pacifico M, Bradley NJ, Williamson RC. Long-term results of distal pancreatectomy for chronic pancreatitis in 90 patients. Ann Surg. 2002;236:612–8.

    Article  Google Scholar 

  13. Lv A, Qian HG, Qiu H, Wu JH, Hao CY. Is central pancreatectomy truly recommendable? A 9-year single-center experience. Dig Surg. 2018;35:532–8.

    Article  Google Scholar 

  14. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.

    Article  Google Scholar 

  15. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  Google Scholar 

  16. American Diabetes A. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(Suppl 1):S81–90.

    Article  Google Scholar 

  17. Hirono S, Tani M, Kawai M, et al. A central pancreatectomy for benign or low-grade malignant neoplasms. J Gastrointest Surg. 2009;13:1659–65.

    Article  Google Scholar 

  18. Sziegoleit A, Krause E, Klor HU, Kanacher L, Linder D. Elastase 1 and chymotrypsin B in pancreatic juice and feces. Clin Biochem. 1989;22:85–9.

    Article  CAS  Google Scholar 

  19. Shin YC, Jang JY, Chang YR, et al. Comparison of long-term clinical outcomes of external and internal pancreatic stents in pancreaticoduodenectomy: randomized controlled study. HPB. 2019;21:51–9.

    Article  Google Scholar 

  20. Hirono S, Yamaue H. Middle pancreatectomy for pancreatic neoplasms. J Hepatobiliary Pancreat Sci. 2010;17:803–7.

    Article  Google Scholar 

  21. Lee SE, Jang JY, Hwang DW, Lee KU, Kim SW. Clinical efficacy of organ-preserving pancreatectomy for benign or low-grade malignant potential lesion. J Korean Med Sci. 2010;25:97–103.

    Article  Google Scholar 

  22. Jang JY, Kim SW, Han JK, et al. Randomized prospective trial of the effect of induced hypergastrinemia on the prevention of pancreatic atrophy after pancreatoduodenectomy in humans. Ann Surg. 2003;237:522–9.

    PubMed  PubMed Central  Google Scholar 

  23. Jang JY, Kim SW, Park SJ, Park YH. Comparison of the functional outcome after pylorus-preserving pancreatoduodenectomy: pancreatogastrostomy and pancreatojejunostomy. World J Surg. 2002;26:366–71.

    Article  Google Scholar 

Download references

Acknowledgement

This work was supported by the Collaborative Genome Program for Fostering New Post-Genome Industry of the National Research Foundation funded by the Ministry of Science and ICT (NRF-2017M3C9A5031597) and the Korean Health Technology R&D Project, Ministry of Health & Welfare (HI14C2640), Republic of Korea.

Author information

Authors and Affiliations

  1. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea

    Doo-Ho Lee MD, Youngmin Han MS, Yoonhyeong Byun MD, Hongbeom Kim MD, Wooil Kwon MD, PhD & Jin-Young Jang MD, PhD, FACS

  2. Department of Surgery, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea

    Doo-Ho Lee MD

Authors
  1. Doo-Ho Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Youngmin Han MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoonhyeong Byun MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hongbeom Kim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wooil Kwon MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jin-Young Jang MD, PhD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jin-Young Jang MD, PhD, FACS.

Ethics declarations

Disclosure

The authors declare no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, DH., Han, Y., Byun, Y. et al. Central Pancreatectomy Versus Distal Pancreatectomy and Pancreaticoduodenectomy for Benign and Low-Grade Malignant Neoplasms: A Retrospective and Propensity Score-Matched Study with Long-Term Functional Outcomes and Pancreas Volumetry. Ann Surg Oncol 27, 1215–1224 (2020). https://doi.org/10.1245/s10434-019-08095-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-019-08095-z

Search

Navigation