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Comparison of Central and Extended Left Pancreatectomy for Lesions of the Pancreatic Neck

¹ Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, 1365C Clifton Rd, NE, 2nd Fl, Atlanta, GA 30322, USA
² University Surgical Unit, University of Southampton School of Medicine, Southampton, UK

Correspondence: Address correspondence and reprint requests to: David A. Kooby, MD; E-mail: dkooby{at}emory.edu

Background: Central pancreatectomy (CP) is a parenchyma-sparing alternative to extended left pancreatectomy (ELP) for tumors of the pancreatic neck. We compared short- and long-term outcomes for the two approaches.

Methods: Patients who underwent CP or ELP from 2000–2007 for neoplasms of the neck were identified. Charts were reviewed for patient, treatment, and outcome data. Long-term and quality-of-life (QoL) data were gathered through Institutional Review Board (IRB)-approved telephone interviews and questionnaires European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, and QLQ-PAN26.

Results: 31 patients were identified; 13 underwent CP and 18 underwent ELP. Median follow-up was 29 months (range 5–90). Groups did not differ in age, American Society of Anesthesiologists (ASA) class, or preexisting diabetes mellitus (DM). CP patients had less gland resected (5.7 ± 2.1 cm versus 10.8 ± 2.8 cm) and lower postoperative mean blood glucose levels (120 ± 15 mg/dl versus 136 ± 24 mg/dl). CP patients experienced more complications (92% versus 39%), but no significant difference in major complications (38%, CP versus 17%, ELP; P = 0.17) or hospital stay (9 ± 3 days, CP versus 7.5 ± 4 days, ELP). There was one perioperative death in the CP group, unrelated to surgical technique. Questionnaire analysis showed no differences in functional or symptom scales. New-onset exocrine insufficiency was not significantly different between the groups (10%, CP versus 27%, ELP; P = 0.62), but the ELP group had a higher rate of new-onset DM (57% versus 11%; P = 0.04).

Conclusion: CP is associated with more complications than ELP, but no difference in long-term QoL. Due to the lower incidence of postoperative DM, CP can be recommended for healthy patients with indolent tumors of the pancreatic neck.

Key Words: Surgical technique • Pancreas neoplasm • Postoperative complications • Diabetes mellitus • Pancreatic fistula • Exocrine insufficiency