Middle segment pancreatectomy: a useful tool in the management of pancreatic neoplasms.

Small, benign or low grade malignant tumours located in the neck of the pancreas are usually treated with enucleation. However if enucleation is too risky because of possible damage to the main pancreatic duct, standard pancreatic resections are performed. Such operations can lead to impaired long term exocrine-endocrine function. Middle segment pancreatectomy consists of a limited resection of the midportion of the pancreas and can be performed in selected patients affected by tumours of the pancreatic neck. Middle segment pancreatectomy is a safe and feasible procedure for treating tumours of the pancreatic neck; in experienced hands it is associated with no mortality but with high morbidity; the rate of "clinical" pancreatic fistula is about 20%. Moreover, it allows the surgeon to preserve pancreatic parenchyma and consequently long term endocrine and exocrine pancreatic function.