Middle segmental pancreatectomy: A safe and organ-preserving option for benign and low-grade malignant lesions

Table 1 Matched-pairs analysis of patient characteristics between patients who underwent middle segmental pancreatectomy, pancreaticoduodenectomy or extended distal pancreatectomy

Variable	PD (n = 44)	MSP (n = 36)	EDP (n = 26)	P value
				PD vs MSP	MSP vs EDP
Patient characteristics
Gender (M/F)	16/28	9/27	11/15	NS	NS
Age (yr)	50 ± 14 (range 18-71)	49 ± 15 (range 23-76)	49 ± 12 (range 22-79)	NS	NS
Tumor type
Cyst adenomas	13	16	16	NS	NS
Endocrine	1	3	2
IPMN	7	3	2
SPT	16	10	1
Others	7	4	5
Tumor size (mm)	30.8 ± 9.6	26.5 ± 14	31.3 ± 13.5	NS	NS
Tumor location
Head-neck	23	8	0	NS	NS
Neck	16	10	0
Neck-body	5	9	15
Body	0	9	11
Preoperative DM	5	2	4	NS	NS

MSP: Middle segmental pancreatectomy; PD: Pancreaticoduodenectomy; EPD: Extended distal pancreatectomy; IPMN: Intraductal papillary mucinous neoplasms; SPT: Solid pseudopapillary tumor; DM: Diabetes mellitus; NS: Not significant.

Table 2 Perioperative outcomes for middle segmental pancreatectomy, pancreaticoduodenectomy and extended distal pancreatectomy n (%)

Variable	PD (n = 44)	MSP (n = 36)	EDP (n = 26)	P value
				PD vs MSP	MSP vs EDP
Operation time (min)	333.5 ± 97	222.1 ± 62.1	202.0 ± 60.7	< 0.001	> 0.05
IPH (mL)	852.2 ± 877.8	316.1 ± 309.6	526.9 ± 414.5	< 0.001	0.025
PT (d)	31 ± 29	29 ± 23	22 ± 10	NS	> 0.05
Reoperation	2 (4.5)	0 (0.0)	0 (0.0)	NS
DGR (d)	5.5 ± 2.1	4.4 ± 2.0	3.2 ± 1.5	0.031	0.008
Bleeding	2 (4.5)	1 (2.8)	1 (3.8)	NS	NS
Intra-abdominal infection	4 (9.1)	1 (2.8)	1 (3.8)	NS	NS
Pancreatic fistula	9 (20.5)	15 (42)	8 (31)	0.039	NS
Nutritional status
Change in TP (%)	-0.5 ± 14.3	3.1 ± 12.4	-6.6 ± 9.5	NS	0.002
Change in Alb (%)	-3.6 ± 15.6	0.8 ± 14.3	-8.2 ± 14.7	NS	0.019
Change in Hb (%)	-13.3 ± 12.6	-11.9 ± 13.2	-14.3 ± 8.0	NS	NS
Mean blood glucose (mmol/L)
Preoperative	5.0 ± 1.1	4.9 ± 0.6	5.2 ± 1.6	NS	NS
Postoperative	6.7 ± 1.8	6.3 ± 1.5	7.3 ± 1.5	NS	0.013

IPH: Intraoperative hemorrhage; PT: Postoperative time; DGR: Duration of gastrointestinal recovery; TP: Total protein; Alb: Albumin; Hb: Hemoglobin; MSP: Middle segmental pancreatectomy; PD: Pancreaticoduodenectomy; EPD: Extended distal pancreatectomy; NS: Not significant.

Table 3 Long-term outcomes following middle segmental pancreatectomy, pancreaticoduodenectomy and extended distal pancreatectomy n (%)

Variable	PD (n = 42)	MSP (n = 36)	EDP (n = 23)	P value
				PD vs MSP	MSP vs EDP
Exocrine and endocrine function
New-onset DM	6 (14.3)	1 (2.8)	5 (21.7)	NS	0.029
NIDDM	4	1	3
IDDM	2	0	2
Enzyme substitution	14 (33.3)	0	5 (21.7)	< 0.001	0.007
Anorexia	9 (21.4)	3 (8.3)	1 (4.3)	NS	NS
Nausea and vomiting	5 (11.9)	2 (5.6)	0	NS	NS
Abdominal distention and diarrhea	16 (38.1)	3 (8.3)	2 (8.7)	0.005	NS
Tumor recurrence	0	0	0
Body weight change1
Weight gain	16	15	8
No change	14	12	8	NS	NS
Weight reduction	12	9	7

¹Wilcoxon rank sum test. DM: Diabetes mellitus; NIDDM: Non insulin dependent diabetes mellitus; IDDM: Insulin dependent diabetes mellitus; MSP: Middle segmental pancreatectomy; PD: Pancreaticoduodenectomy; EPD: Extended distal pancreatectomy; NS: Not significant.