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Middle Preserving Pancreatectomy: A Viable Option for Parenchyma Preserving Pancreatic Resection

Vikas Gupta, Vikash Moond, Santhosh Irrinki, Ashwini Sood, Ajay Gulati, Amanjit Bal, KimVaiphei, Saroj K Sinha, Rakesh Kochhar

Background Multicentric pancreatic neoplasm offers a unique challenge to the surgeon with respect to the surgical procedure to be performed. Traditionally total Pancreatectomy was considered as the standard treatment in these patients. But due to the inevitable pancreatic state associated with the procedure alternative parenchyma sparing pancreatic surgeries have evolved as effective options. Middle preserving pancreatectomy is one such option when the pancreatic body is unaffected by any pathology. Methodology Two patients with multi centric pancreatic tumors who underwent middle preserving pancreatectomy for suspected neuroendocrine tumor were reviewed. We have also reviewed the English literature and found 26 cases of middle preserving pancreatectomy. The demographic, intra-operative and postoperative morbidity, mortality and the risk of pancreatic insufficiency associated with the procedure were evaluated. Results The overall morbidity was 32.1% (9/28), pancreatic fistula rate 17.8% (5/28), risk of re-operation estimated as 3.5% (1/28). There was no perioperative mortality. . The rate of endocrine and exocrine insufficiency to be 25% (7/28) and 17.8% (5/28), respectively. The reported length of remnant pancreas has varied between 2cm to 8 cm. There has been no reported case of pancreatic remnant necrosis and disease recurrence in the remnant pancreas on follow up. Conclusion Middle preserving pancreatectomy is a feasible, safe and effective alternative in carefully selected patients with benign or low grade multicentric pancreatic neoplasms.