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Pylorus‐preserving total pancreatectomy for an intraductal papillary‐mucinous neoplasm of the pancreas
Author(s) -
Inagaki Mitsuhiro,
Obara Mitsuhiro,
Kino Shuichi,
Goto Junichi,
Suzuki Shigeki,
Ishizaki Akira,
Tanno Satoshi,
Kohgo Yutaka,
Tokusashi Yoshihiko,
Miyokawa Naoyuki,
Kasai Shinichi
Publication year - 2007
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-006-1146-9
Subject(s) - medicine , splenectomy , pancreas , pancreatectomy , gastroenterology , lymph , pylorus , intraductal papillary mucinous neoplasm , stomach , pathology , spleen
Background/Purpose Total pancreatectomy (TP) is rarely performed to treat invasive ductal carcinoma of the pancreas, due to the associated markedly impaired quality of life and poor prognosis after the resection. Intraductal papillary‐mucinous neoplasm (IPMN) of the pancreas is characterized by extensive intraductal spread and a favorable outcome even when presenting at an invasive stage. We herein reappraise the role of pylorus‐preserving total pancreatectomy (PPTP) as a viable alternative pancreatic resection modality for borderline and malignant IPMN. Methods A total of five patients with IPMN underwent PPTP and their clinical follow‐up data were reviewed. Results TP was performed due to recurrent IPMN in the remnant pancreas after distal pancreatectomy in three patients and due to massive involvement of the entire pancreas in the others. All patients were treated by the pylorus‐preserving method, while the spleen was also preserved in one patient. The surgical margins were negative and no metastasis to the resected lymph nodes was evident, based on histological examinations. One patient underwent a re‐operation due to postoperative intraabdominal bleeding, while another patient required tubedrainage for left pleural effusion. Three of the four patients who underwent PPTP with a splenectomy experienced postoperative gastric ulcer, which were controlled by medication. One patient died due to suicide 16 months after the PPTP. All the others were doing well without recurrence at periods of 62 to 127 months after the PPTP. Conclusions PPTP is therefore considered to be indicated as an effective treatment for borderline or malignant IPMN with extensive involvement, when the patient's condition permits, in order to achieve complete resection of the IPMN.