Outcome of duodenum-preserving resection of the head of the pancreas for intraductal papillary-mucinous neoplasm.
BACKGROUND
The standard surgical procedure for intraductal papillary-mucinous neoplasm of the pancreatic head is pylorus-preserving pancreatoduodenectomy. A less extensive resection may be justified because most intraductal papillary-mucinous neoplasms are benign or of low-grade malignancy.


OBJECTIVE
The outcome of duodenum-preserving pancreatic head resection with preservation of the main bile duct was evaluated retrospectively in 13 patients with a branch-type intraductal papillary-mucinous neoplasm in the head of the pancreas and with a median (range) follow-up of 60.0 (0.3-99.5) months.


RESULTS
Post-operative complications included anastomotic leakage (n=3), bile duct perforation (n=1), intra-abdominal bleeding (n=3), delayed gastric emptying (n=2) and death (n=2). All the resection margins were clear of tumour on histological examination. Ten of 11 patients maintained over 90% of their pre-operative body weight. Glucose tolerance improved in 4 of 11 evaluable patients, was unchanged in 6 and worsened in 1 patient. Biliary scintigraphy showed that bile flow was delayed compared with that before surgery (8.8 +/- 1.1 vs. 19.6 +/- 4.6 min; p = 0.03). Neither recurrence nor metastasis was observed.


CONCLUSIONS
The results of duodenum-preserving pancreatic head resection for branch duct-type intraductal papillary-mucinous neoplasm were satisfactory and provided a good quality of life.
Hirano
Satoshi
S
Department of Surgical Oncology, Division of Cancer Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan. satto@med.hokudai.ac.jp
Kondo
Satoshi
S
Ambo
Yoshiyasu
Y
Tanaka
Eiichi
E
Morikawa
Toshiaki
T
Okushiba
Shunichi
S
Katoh
Hiroyuki
H
D002288:Adenocarcinoma, Mucinous / Q000601:surgery*; D000231:Adenocarcinoma, Papillary / Q000601:surgery*; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D004386:Duodenum; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome