Pancreas-preserving biliary amputation with pancreatic diversion: a new surgical technique for complete resection of the intrapancreatic biliary system.
Pancreatoduodenectomy is not optimal for organ preservation in patients with mucosal carcinoma of the choledochus. When the lesion spreads near the papilla of Vater, pancreas-preserving biliary amputation may be indicated to achieve complete resection of the biliary system. The first successful case is reported here with technical considerations. First, the pancreatic neck was divided and a tube was inserted into the main pancreatic duct beyond the papilla. The choledochus was dissected downward with division of the posterior pancreatoduodenal vessels. The main pancreatic duct was isolated with the aid of palpation of the tube, and was then ligated and divided. Subsequent dissection was performed to the level of the duodenal mucosa, which was incised circularly. The duodenal defect was then closed. The elevated jejunum was interposed between the pancreatic stumps and bilateral pancreaticojejunostomies were created. The procedure was successfully performed in a patient with superficially spreading cholangiocarcinoma. Postoperative bile leak and pancreatic fistula were controlled with medical management. The patient is currently well without tumor recurrence 19 months after surgery. Her glucose tolerance, which was moderately impaired preoperatively, has been maintained. Pancreas-preserving biliary amputation has been developed as an organ-preserving procedure alternative to pancreatoduodenectomy. Indications, methods of pancreatic reconstruction, and long-term results require further study.
Kondo
Satoshi
S
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine N15 W7 Kita-ku, Sapporo 060-8638, Japan. kondows@med.hokudai.ac.jp
Hirano
Satoshi
S
Ambo
Yoshiyasu
Y
Tanaka
Eiichi
E
Morikawa
Toshiaki
T
Okushiba
Shunichi
S
Katoh
Hiroyuki
H
D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery; D017734:Bile Ducts, Extrahepatic / Q000473:pathology / Q000601:surgery; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D003135:Common Bile Duct / Q000473:pathology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010180:Pancreatectomy / Q000379:methods*; D010183:Pancreatic Ducts / Q000473:pathology / Q000601:surgery*; D010193:Pancreaticojejunostomy / Q000379:methods*