Median Pancreatectomy for Benign and Low-Grade Malignant Pancreatic Lesions: An 11-Year Single-Center Experience With Perioperative and Functional Outcomes.

Background Median pancreatectomy (MP) is a parenchyma-sparing procedure for benign and low-grade malignant lesions of the pancreatic neck and body, with the potential to preserve endocrine and exocrine function. However, concerns regarding postoperative pancreatic fistula (POPF) have limited its widespread adoption. Methods This retrospective cohort study included 23 consecutive patients who underwent MP at a tertiary referral centre between January 2015 and December 2025. POPF was classified using the 2016 International Study Group of Pancreatic Surgery criteria, and long-term endocrine and exocrine function was assessed during follow-up. Results The mean age was 43.57 ± 15.05 years, and 91.3% of the patients were female. Common indications included cystic neoplasms (60.9%), neuroendocrine tumours (21.7%), and solid pseudopapillary neoplasms. Biochemical leak occurred in 60.9% of patients, and Grade B POPF occurred in 30.4%. Patients with Grade B POPF had a significantly longer hospital stay than those with biochemical leak (25.00 ± 15.41 vs. 14.29 ± 7.53 days, p = 0.039). No mortality was observed. At a median follow-up of 98 months (range, 4-130 months), only one patient (4.3%) developed new-onset diabetes, and none developed exocrine insufficiency. Conclusion MP is a safe and effective parenchyma-sparing procedure with excellent long-term preservation of pancreatic function, despite the high incidence of biochemical leak and Grade B POPF, which can generally be managed conservatively with appropriate clinical care.