title: Spleen-preserving distal pancreatectomy for intraductal papillary-mucinous tumor (IPMT).
abstract: OBJECTIVE
  Recently, the significance of preserving the spleen has received a lot of attention. Since our first trial and success of spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein for chronic pancreatitis, this procedure has been more frequently performed and reported. In this study, we introduce the technique and indications for the procedure for intraductal papillary mucinous tumor of the pancreas.
  
  
  METHODS
  Nine patients underwent spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. We performed this procedure in two patients with intraductal papillary mucinous tumor. The splenic vein is identified behind the pancreas and within the thin connective tissue membrane. The connective tissue membrane is cut longitudinally above the splenic vein. An important technique is to remove the splenic vein from the pancreas from the body of the pancreas toward the spleen. There are many branches from the splenic vein on both sides, and these branches should be carefully ligated and cut. The pancreas is removed from the splenic artery from the spleen toward the head of the pancreas. This procedure is much easier than removing the pancreas from the vein.
  
  
  RESULTS
  The postoperative course was uneventful in all nine cases, but one, in which pancreatic fistula continued for more than several weeks. The mean and standard deviation of the operative blood loss, the duration of the operation and the postoperative hospital stay in seven cases, excluding two cases, in which either Puestow's procedure or simultaneous subtotal esophagectomy was performed, were 413+/-385 mL, 298+/-55 min, and 39+/-15 days, respectively. Severe complications were not found in any of the nine cases. The two patients with intraductal papillary mucinous tumor have been followed as outpatients without any recurrence.
  
  
  CONCLUSIONS
  Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein is easy and safe, and should be performed for some of the patients with intraductal papillary mucinous tumor of the pancreas.
authors.affiliation: First Department of Surgery, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Kimura
authors.forename: Akira
authors.initials: A
authors.lastname: Fuse
authors.forename: Ichirou
authors.initials: I
authors.lastname: Hirai
authors.forename: Koichi
authors.initials: K
authors.lastname: Suto
mesh_terms: D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000378:metabolism / Q000601:surgery*; D018291:Cystadenoma, Mucinous / Q000601:surgery*; D018292:Cystadenoma, Papillary / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000378:metabolism; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*
chemical_list: D009077:Mucins