Central Pancreatectomy as a Surgical Alternative for Parenchyma Preservation

Pancreatoduodenectomy and distal pancreatectomy are standard treatments for various pancreatic pathologies. These procedures involve radical resection and a significant loss of pancreatic tissue, which can lead to exocrine and/or endocrine pancreatic insufficiency. In selected cases of benign tumors or those with low malignant potential, central pancreatectomy can be performed with acceptable morbidity and mortality rates. The advantage of preserving the maximum amount of healthy pancreatic tissue is the retention of both exocrine and endocrine pancreatic function. We present the case of a 45-year-old female patient with a history of conversion from sleeve gastrectomy to Roux-en-Y gastric bypass three years prior due to gastroesophageal reflux disease (GERD). She presented with a pancreatic cystic lesion incidentally detected during abdominal ultrasound screening. Magnetic resonance imaging (MRI) revealed a 20 mm cystic lesion in the neck of the pancreas without signs of aggressiveness. Endoscopic ultrasound showed no features suggesting malignancy, with aspirated citrine-colored fluid, carcinoembryonic antigen (CEA) < 1.8 ng/mL, amylase of 144 U/L, glucose of 102 mg/dL, and cytology positive for neuroendocrine tumor of the pancreas (pNET). A PET scan with octreotide showed hyperuptake in the pancreas, with no evidence of additional lesions. An open central pancreatectomy was performed without complications. The patient had a favorable postoperative course and was discharged on day 5 without a pancreatic fistula. Biopsy confirmed a well-differentiated 2.1 cm grade 1 neuroendocrine tumor (G1 NET). Surgical margins were negative, with no vascular, lymphatic, or perineural invasion (pT2N0). At the five-month follow-up, the patient was asymptomatic, with a control abdominal PET-CT showing no abnormalities. A retrospective review of the patient's medical records and a literature review were performed.