Central segmental pancreatectomy in benign and borderline neoplasms of the pancreatic isthmus and body

: We report our experience with middle segment pancreatectomy for benign, cystic and borderline tumours of the neck and body of the pancreas. The guidelines for management of these tumours are unclear. Formerly they were usually resected with a pancreatico-duodenectomy or distal pancreatectomy including the spleen. However, such operations may cause high morbidity, a notable wastage of normal tissue and an unnecessary risk of diabetes mellitus and splenic loss. Four patients (age range: 34-72 years) with tumours of the neck or body of the pancreas underwent a middle segmental pancreatectomy. The cephalic stump was sutured with duct ligation. The distal stump was anastomosed with a Roux-en-Y jejunal loop. Neither pancreatic fistulas nor operative death occurred in any of the patients. In 3 patients with serous cystadenoma and in one with mucinous cystadenoma, the tumours measured 3.5 to 7 cm in size. These were located in the neck and body of the pancreas and could not be safely enucleated without compromising the pancreatic duct. All tumours were resected with clear margins. The mean operative time was 230 minutes and the median postoperative hospital stay 14 days (range: 10-23 days). The patients have been followed up for five years after surgery and all are disease-free. None of the patients became diabetic or presented exocrine insufficiency. Middle segment pancreatectomy may be an appropriate technique for selected benign or borderline pancreatic tumours in the neck and body of the pancreas. This procedure has an acceptable surgical risk when compared to that of major pancreatic resections and preserves pancreatic function and the spleen.