Systematic review of central pancreatectomy and meta-analysis of central versus distal pancreatectomy

Background: Central pancreatectomy (CP) is a parenchyma-sparing surgical procedure that enables the removal of benign and/or low-grade malignant lesions from the neck and proximal body of the pancreas. The aim of this review was to evaluate the short-and long-term surgical results of CP from all published studies, and the results of comparative studies of CP versus distal pancreatectomy (DP). Methods: Eligible studies published between 1988 and 2010 were reviewed systematically. Comparisons between CP and DP were pooled and analysed by meta-analytical techniques using random-or fixed-effects models, as appropriate. Results: Ninety-four studies, involving 963 patients undergoing CP, were identified. Postoperative morbidity and pancreatic fistula rates were 45.3 and 40.9 per cent respectively. Endocrine and exocrine pancreatic insufficiency was reported in 5.0 and 9.9 per cent of patients. The overall mortality rate was 0.8 per cent. Compared with DP, CP had a higher postoperative morbidity rate and a higher incidence of pancreatic fistula, but a lower risk of endocrine insufficiency (relative risk (RR) 0.22, 95 per cent confidence interval 0.14 to 0.35; P < 0.001). The risk of exocrine failure was also lower after CP, although this was not significant (RR 0.59, 0.32 to 1.07; P = 0.082). Conclusion: CP is a safe procedure with good long-term functional reserve. In situations where DP represents an alternative, CP is associated with a slightly higher risk of early complications. Presented in part to the Annual Meeting of the Society for Surgery of the Alimentary Tract, during Digestive Disease Week 2011, Chicago, Illinois, USA, May 2011, and the Tenth World Congress of the International Hepato-Pancreato-Biliary Association, Paris, France, July 2012; published in part in abstract form as Gastroenterology 2011; 140(Suppl 1):S-1038-S-1039