title: Spleen-preserving distal pancreatectomy with preservation of the splenic artery and vein for intraductal papillary-mucinous tumor (IPMT): three interesting cases.
abstract: Preservation of the spleen at distal pancreatectomy has recently attracted considerable attention. Since our first trial and success with spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein for tumors of the pancreas and chronic pancreatitis, this procedure has been performed more frequently. Three patients with intraductal papillary-mucinous tumor underwent spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. In this procedure, the splenic vein is identified behind the pancreas and the connective tissue membrane is cut longitudinally above the splenic vein. An important point is to remove the splenic vein from the pancreas from the body of the pancreas toward the spleen. In one patient with intraductal papillary-mucinous tumor in the body of the pancreas who had undergone distal gastrectomy for duodenal ulcer 32 years previously, residual proximal gastrectomy could be avoided with this procedure. In this case, the histological diagnosis was a pseudocyst, and epithelial dysplasia was found in other pancreatic ductuli. In another case, epithelia were borderline between hyperplasia and adenoma. In both of these cases, the histological diagnosis was different from the preoperative diagnosis. Even with advances in imaging techniques, diagnosis of a cystic lesion of the pancreas is still very difficult. Ordinary distal pancreatectomy with splenectomy would have been oversurgery in these two cases, which could be avoided using our procedure. Severe complications were not found in any of the three cases and the postoperative course was uneventful. The patients have been followed as outpatients without any recurrence. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein is easy and safe, and should be performed for some patients with intraductal papillary mucinous tumor of the pancreas.
authors.affiliation: Department of Organ Function and Controls, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata City, Yamagata 990-9585, Japan. wkimura@med.id.yamagata-u.ac.jp
authors.forename: Wataru
authors.initials: W
authors.lastname: Kimura
authors.forename: Akira
authors.initials: A
authors.lastname: Fuse
authors.forename: Ichiro
authors.initials: I
authors.lastname: Hirai
authors.forename: Koichi
authors.initials: K
authors.lastname: Suto
authors.forename: Akihiko
authors.initials: A
authors.lastname: Suzuki
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Moriya
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Sakurai
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000601:surgery*; D000231:Adenocarcinoma, Papillary / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000601:surgery*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D010180:Pancreatectomy / Q000379:methods*; D010181:Pancreatic Cyst / Q000175:diagnosis / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012086:Reoperation; D013156:Splenectomy; D013157:Splenic Artery / Q000601:surgery*; D013162:Splenic Vein / Q000601:surgery*