0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Operative Technique |

Central Pancreatectomy:  A Technique for the Resection of Pancreatic Neck Lesions

John D. Christein, MD; Rory L. Smoot, MD; Michael B. Farnell, MD
Arch Surg. 2006;141(3):293-299. doi:10.1001/archsurg.141.3.293.
Text Size: A A A
Published online

Hypothesis  Central pancreatectomy has been used sparingly because the spectrum of indications is quite narrow. Although historically used for traumatic pancreatic transection and chronic pancreatitis, it currently is reserved for selective management of pancreatic neck lesions that are benign or have low malignant potential. Varying morbidity rates have been published in the literature. Our objectives were to describe the technique and determine the safety and effectiveness of central pancreatectomy in the excision of benign or low–malignant potential lesions of the pancreatic neck.

Design  Retrospective clinicopathologic data review.

Setting  The Mayo Clinic surgical index was used to identify procedures matched for central, median, middle, or middle segment pancreatectomy.

Patients  Eight patients (4 men, 4 women) underwent central pancreatectomy between 1998 and 2004.

Intervention  Patients with pancreatic neck or proximal body masses underwent central pancreatectomy at the Mayo Clinic, Rochester, Minn.

Main Outcome Measures  Patients were followed up closely for postoperative complications during the initial hospital admission. On follow-up, long-term endocrine and exocrine function were determined based on laboratory values and patient history.

Results  Abnormalities included 3 islet cell tumors, 2 serous cystadenomas, a mucinous cystadenoma, a lymphoepithelial cyst, and a recurrent liposarcoma. Mean tumor size was 2.8 cm and mean operative time was 4.8 hours with a mean blood loss of 381 mL. The most common complication was pancreatic leak (5 patients [63%]). Reoperation was necessary in 2 patients (25%), both secondary to hemorrhage. There was no mortality or new-onset diabetes mellitus. One patient transiently required oral pancreatic enzyme supplementation.

Conclusions  Central pancreatectomy may preserve endocrine and exocrine function. While mortality is low, in our experience, central pancreatectomy is associated with a high complication rate. The most common complication is pancreatic leak. Caution is necessary when using central pancreatectomy in the treatment of pancreatic neck lesions. Surgeon experience is of utmost importance in this decision-making process as well as the technical aspects of central pancreatectomy. The precise role of central pancreatectomy in the management of benign or low–malignant potential lesions of the neck of the pancreas remains in evolution.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure 1.

A Kocher maneuver is performed to assess the head of the pancreas as well as the relationship of the tumor to the superior mesenteric artery. IVC indicates inferior vena cava.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Microcystic (serous) cystadenoma at the pancreatic neck, near the superior mesenteric-splenic vein confluence.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Islet cell tumor of the pancreatic neck just superior to the superior mesenteric-splenic vein confluence.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

Exposure of the superior mesenteric vein. A, The gastrocolic venous trunk is divided to allow optimal exposure of the superior mesenteric vein prior to dissection posterior to the neck of the pancreas. B, A blunt dissector is carefully passed into the plane between the pancreas and the superior mesenteric vein.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.

The peritoneum along the superior and inferior borders of the pancreas is incised to allow for adequate mobilization. T indicates location of tumor.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 6.

Mobilization of the neck of the pancreas. A, While mobilizing the tumor, the plane superior and posterior to the pancreas is dissected and multiple small branches to the splenic vein and artery are ligated. B, The main pancreatic duct within the pancreatic head is individually ligated with permanent suture. C, Full-thickness permanent suture is used to approximate the capsule from the anterior to the posterior aspect of the transected pancreatic neck. T indicates location of tumor.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 7.

Construction of the pancreaticojejunostomy. A, A 2-layer, end-to-side, duct-to-mucosa pancreaticojejunostomy is performed over a free-floating Silastic stent. B, Reconstruction after central pancreatectomy with a retrocolic Roux limb to the pancreaticojejunostomy.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 44

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();