Total pancreaticoduodenectomy and segmental resection of superior mesenteric vein-portal vein confluence with autologous splenic vein graft in mucinous cystadenocarcinoma of the pancreas.
BACKGROUND
Mucinous cystic tumors occur almost exclusively in middle-aged women and in the body or tail of the pancreas. Mucinous cystadenocarcinoma, a malignant sub-type of mucinous cystic tumors, in the head of the pancreas and in a middle-aged man is extraordinary, and the prognosis and proper management of mucinous cystadenocarcinoma has not been well documented.


METHODS
A 52-year-old male patient with a mucinous cystadenocarcinoma approximately 5.5 cm in size in the head of the pancreas underwent a total pancreaticoduodenectomy and segmental resection of the superior mesenteric vein-portal vein confluence with an autologous splenic vein graft due to tumor invasion. His postoperative course was uneventful and he received adjuvant chemotherapy. He has been followed-up periodically for more than 30 months after surgery without evidence of recurrence.


CONCLUSIONS
Mucinous cystadenocarcinoma in the head of the pancreas in a middle-aged man is an extremely rare case. Because mucinous cystadenocarcinomas have a relatively good prognosis, an aggressive approach with major vascular resection is warranted in well-selected patients. Splenic vein interposition grafting could be used in cases which undergo total pancreaticoduodenectomy with segmental resection of the superior mesenteric vein-portal vein confluence if the splenic vein is healthy.
Division of Biliopancreas, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Sung Hoon
SH
Choi
Ho Kyoung
HK
Hwang
Chang Moo
CM
Kang
Woo Jung
WJ
Lee
D018282:Cystadenocarcinoma, Mucinous / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D013162:Splenic Vein / Q000637:transplantation*; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous