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Medline ® Abstract for Reference 100

of 'Surgical resection of lesions of the body and tail of the pancreas'

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Reappraisal of central pancreatectomy a 12-year single-center experience.
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Goudard Y, Gaujoux S, Dokmak S, Cros J, Couvelard A, Palazzo M, Ronot M, Vullierme MP, Ruszniewski P, Belghiti J, Sauvanet A
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JAMA Surg. 2014 Apr;149(4):356-63.
 
IMPORTANCE: Central pancreatectomy, as an alternative to standard resection for benign and low-grade pancreatic neoplasms, has been described in mainly small retrospective series.
OBJECTIVE: To describe a large single-center experience with central pancreatectomy.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective case series in a tertiary referral center included 100 consecutive patients undergoing central pancreatectomy with pancreaticogastrostomy from January 1, 2000, to March 1, 2012.
MAIN OUTCOMES AND MEASURES: Surgical indications, postoperative morbidity, mortality, and long-term outcomes regarding pancreatic function and recurrence.
RESULTS: Central pancreatectomies were performed mainly for neuroendocrine tumors (35%), intraductal papillary mucinous neoplasms (33%), solid pseudopapillary neoplasms(12%), and mucinous cystadenomas (6%). The postoperative mortality rate was 3% (due to pulmonary embolisms in 2 patients and hemorrhage after pancreatic fistula in 1 patient). Clavien-Dindo III or IV complications occurred in 15%of patients and were due mainly to pancreatic fistula, requiring 10 radiologic drainage procedures, 7 endoscopic procedures, and 6 reoperations overall. After a median follow-up of 36 months, the rates of new-onset exocrine and endocrine insufficiency were 6%and 2%, respectively. Overall, 7 lesions could be considered undertreated, including 3 node-negative R0 microinvasive intraductal papillary mucinous neoplasms (without recurrence at 27, 29, and 34 months) and 4 node-positive neuroendocrine tumors (with 1 hepatic recurrence at 66 months). Among the 25 patients with a doubtful preoperative diagnosis, 9 could be considered over treated (ie, operated on for benign non evolutive asymptomatic lesions).
CONCLUSIONS AND RELEVANCE: Central pancreatectomy is associated with an excellent pancreatic function at the expense of a significant morbidity and a non-nil mortality rate,underestimated by the published literature. The procedure is best indicated for benign or low-grade lesions in young and fit patients who can sustain a significant postoperative morbidity and could benefit from the excellent long-term results.
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