title: Pylorus-preserving total pancreatectomy for an intraductal papillary-mucinous neoplasm of the pancreas.
abstract: OBJECTIVE
  Total pancreatectomy (TP) is rarely performed to treat invasive ductal carcinoma of the pancreas, due to the associated markedly impaired quality of life and poor prognosis after the resection. Intraductal papillary-mucinous neoplasm (IPMN) of the pancreas is characterized by extensive intraductal spread and a favorable outcome even when presenting at an invasive stage. We herein reappraise the role of pylorus-preserving total pancreatectomy (PPTP) as a viable alternative pancreatic resection modality for borderline and malignant IPMN.
  
  
  METHODS
  A total of five patients with IPMN underwent PPTP and their clinical follow-up data were reviewed.
  
  
  RESULTS
  TP was performed due to recurrent IPMN in the remnant pancreas after distal pancreatectomy in three patients and due to massive involvement of the entire pancreas in the others. All patients were treated by the pylorus-preserving method, while the spleen was also preserved in one patient. The surgical margins were negative and no metastasis to the resected lymph nodes was evident, based on histological examinations. One patient underwent a re-operation due to postoperative intraabdominal bleeding, while another patient required tubedrainage for left pleural effusion. Three of the four patients who underwent PPTP with a splenectomy experienced postoperative gastric ulcer, which were controlled by medication. One patient died due to suicide 16 months after the PPTP. All the others were doing well without recurrence at periods of 62 to 127 months after the PPTP.
  
  
  CONCLUSIONS
  PPTP is therefore considered to be indicated as an effective treatment for borderline or malignant IPMN with extensive involvement, when the patient's condition permits, in order to achieve complete resection of the IPMN.
authors.affiliation: Department of Surgery, Asahikawa Medical College, 2-1-1-1 Midorigaoka-Higashi, Asahikawa 078-8510, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Inagaki
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Obara
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kino
authors.forename: Junichi
authors.initials: J
authors.lastname: Goto
authors.forename: Shigeki
authors.initials: S
authors.lastname: Suzuki
authors.forename: Akira
authors.initials: A
authors.lastname: Ishizaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tanno
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kohgo
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Tokusashi
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Miyokawa
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kasai
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*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome