Central pancreatectomy: a Latin American experience of parenchyma-sparing surgery for benign and low-grade pancreatic neoplasmsBackground: Central pancreatectomy (CP) is a parenchyma-sparing alternative to standard resections for benign or low-grade lesions of the pancreatic neck. While it aims to preserve endocrine and exocrine function, it is associated with significant technical complexity and high rates of postoperative pancreatic fistula (POPF).
Aims: To analyze the CP at a single high-volume Brazilian center.
Methods: A retrospective analysis of a prospectively maintained database was conducted. All patients undergoing CP at a single high-volume Brazilian center between January 2009 and December 2024 were included. Data on demographics, operative details, pathology, complications (International Study Group of Pancreatic Surgery – ISGPS/Clavien-Dindo criteria), and long-term pancreatic function were collected.
Results: Twenty-two patients underwent CP (mean age 54 years, 72% female). The majority of lesions were cystic (50%) or neuroendocrine tumors (36.4%). The POPF rate was 86.4%, all Grade B, most managed conservatively via prolonged drainage. No Grade C fistulas, postoperative hemorrhages, or mortality occurred. Delayed gastric emptying occurred in 22.7%. After a median follow-up of 5.59 years, endocrine insufficiency developed in 9% of patients without prior diabetes (none insulin-dependent), and exocrine insufficiency in 13.6%. Only one locoregional recurrence was observed (isolated metastasis).
Conclusions: This first Latin American series demonstrates that central pancreatectomy is a feasible and effective parenchyma-sparing procedure. It provides excellent long-term preservation of pancreatic function with low severe morbidity, despite high rates of manageable POPF. These outcomes support its role as a valuable surgical option for selected patients in experienced centers.
Headings:
Pancreas; Pancreatectomy; Pancreatic neoplasms
Central pancreatectomy is a feasible parenchyma-sparing option for benign and low-grade pancreatic neck lesions in experienced centers.
Despite a high rate of postoperative pancreatic fistula, morbidity is predominantly moderate and managed conservatively, with no severe fistulas or mortality.
Long-term endocrine and exocrine pancreatic function is largely preserved, with very low rates of clinically relevant insufficiency.
CENTRAL MESSAGE This original Latin American series demonstrates that central pancreatectomy can be safely performed for selected benign and low-grade pancreatic neoplasms, offering substantial preservation of pancreatic function. Although postoperative pancreatic fistula was frequent, all cases were grade B and predominantly managed without invasive interventions. The absence of severe complications, reoperations, or mortality, combined with excellent long-term endocrine and exocrine outcomes, supports central pancreatectomy as a valuable alternative to standard pancreatic resections when performed in high-volume, experienced centers.
PERSPECTIVES This study reinforces the long-term functional value of central pancreatectomy. The findings highlight that a high incidence of postoperative pancreatic fistula does not necessarily translate into severe complications or compromised recovery when managed within structured protocols. By demonstrating durable preservation of endocrine and exocrine function with acceptable oncologic control, this experience supports a more nuanced, patient-centered approach to pancreatic surgery, encouraging refinement of indications and perioperative strategies for parenchyma-sparing resections.
