Middle segment preserving pancreatectomy versus total pancreatectomy: a comparative analysis of short- and long-term outcomes

Purpose: Middle-segment preserving pancreatectomy (MSPP) serves as an alternative to total pancreatectomy (TP) for preserving the pancreatic body in multifocal pancreatic neoplasms. Despite the potential benefits of TP, the detailed short- and long-term prognoses remain unclear. We evaluated the feasibility of MSPP by comparing the perioperative outcomes and postoperative endocrine and exocrine functions with those of TP.

Methods: The study included 10 TP and 7 MSPP patients. Patients with pancreatic ductal adenocarcinoma and invasive intraductal papillary mucinous carcinoma were excluded.

Results: MSPP was associated with a high incidence (57.1%) of postoperative pancreatic fistula (POPF); however, there were no cases of post-pancreatectomy hemorrhage or postoperative mortality in any group. The postoperative hospital stay and readmission rates were comparable between the groups. At 1 year postoperatively, MSPP reduced the risk of new-onset insulin-dependent diabetes mellitus, maintained good glycemic control with minimal hypoglycemic events, and preserved skeletal muscle, subcutaneous fat, and visceral fat. One patient in the MSPP group with a neuroendocrine tumor had postoperative recurrence in the para-aortic lymph node.

Conclusions: Despite the high POPF rate and oncologic limitations, MSPP showed superior long-term outcomes in glycemic control and preservation of body composition. MSPP may be an acceptable treatment option for selected patients.