title: Safe management of the pancreatic remnant with prolamine duct occlusion after extended pancreaticoduodenectomy.
abstract: OBJECTIVE
  Occlusion of the pancreatic duct system has been used to prevent pancreatic leakage by abolishing pancreatic exocrine secretion in pancreatic surgery. However, ductal occlusion has not proved satisfactory for preventing pancreatic fistulas in pancreaticoduodenectomy (PD).
  
  
  METHODS
  Pancreatic duct occlusion with a watertight drainage system around the pancreatic stump was performed following extended PD in 17 patients with (n=12) or without (n=5) a dilated pancreatic duct.
  
  
  RESULTS
  Transient pancreatitis during the early postoperative period occurred in all patients with a nondilated pancreatic duct. No patient developed pancreatic fistula or any other serious complication in both groups.
  
  
  CONCLUSIONS
  Pancreatic duct occlusion may minimize the risk of pancreatic leakage in patients with a nondilated pancreatic duct and a normal pancreas as well as in those with a dilated, obstructed pancreatic duct without compromising the postoperative quality of life. This is a safe and reliable technique for managing the pancreatic remnant in patients undergoing extended PD for advanced pancreaticobiliary malignancy.
authors.affiliation: Department of Hepatobiliary Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan. kshimada@ncc.go.jp
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimada
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sano
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Tomoo
authors.initials: T
authors.lastname: Kosuge
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000188:drug therapy*; D010183:Pancreatic Ducts / Q000187:drug effects* / Q000503:physiopathology; D010185:Pancreatic Fistula / Q000517:prevention & control*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D010665:Phenylpropanolamine / Q000627:therapeutic use*; D011182:Postoperative Care / Q000379:methods; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D016896:Treatment Outcome
chemical_list: D010665:Phenylpropanolamine