Middle Segment-Preserving Pancreatectomy to Avoid Pancreatic Insufficiency: Individual Patient Data Analysis of All Published Cases from 2003-2021

• Published in: Journal of clinical medicine Vol. 12; no. 5; p. 2013
• Main Authors: Pausch, Thomas M, Liu, Xinchun, Dincher, Josefine, Contin, Pietro, Cui, Jiaqu, Wei, Jishu, Heger, Ulrike, Lang, Matthias, Tanaka, Masayuki, Heap, Stephen, Kaiser, Jörg, Klotz, Rosa, Probst, Pascal, Miao, Yi, Hackert, Thilo
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 03-03-2023; MDPI
• Subjects: Bias; Care and treatment; Clinical medicine; Datasets; Development and progression; Diagnosis; Generalized linear models; Health aspects; Metastasis; Pancreatectomy; Pancreatic cancer; Pancreatitis; Patient outcomes; Patients; Quality of life; Surgery; Surgical outcomes; Japan; retrospective studies; pancreatectomy/methods; pancreatectomy/adverse effects; pancreas/surgery
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm12052013

Middle segment-preserving pancreatectomy (MPP) can treat multilocular diseases in the pancreatic head and tail while avoiding impairments caused by total pancreatectomy (TP). We conducted a systematic literature review of MPP cases and collected individual patient data (IPD). MPP patients (N = 29) were analyzed and compared to a group of TP patients (N = 14) in terms of clinical baseline characteristics, intraoperative course, and postoperative outcomes. We also conducted a limited survival analysis following MPP. Pancreatic functionality was better preserved following MPP than TP, as new-onset diabetes and exocrine insufficiency each occurred in 29% of MPP patients compared to near-ubiquitous prevalence among TP patients. Nevertheless, POPF Grade B occurred in 54% of MPP patients, a complication avoidable with TP. Longer pancreatic remnants were a prognostic indicator for shorter and less eventful hospital stays with fewer complications, whereas complications of endocrine functionality were associated with older patients. Long-term survival prospects after MPP appeared strong (median up to 110 months), but survival was lower in cases with recurring malignancies and metastases (median < 40 months). This study demonstrates MPP is a feasible treatment alternative to TP for selected cases because it can avoid pancreoprivic impairments, but at the risk of perioperative morbidity.