Repeated pancreatectomy after pancreato-duodenectomy for a intraductal papillary mucinous tumour: advantage of pancreatico-gastrostomy with a gastric partition.
BACKGROUND
Regular follow-up and monitoring of intraductal papillary mucinous neoplasms (IPMN) is important as there is a risk of recurrence in both the non-invasive and invasive IPMN.


METHODS
Three patients developed pancreatic remnant recurrence after a pancreatico-duodenectomy for IPMN. Pancreatico-gastrostomy anastomosis was performed in all patients. Long-term follow-up was performed with radiographical surveillance and by endoscopic gastroscopy.


RESULTS
Magnetic resonance imaging (MRI) and endoscopic ultrasonography (EUS) revealed in one patient, 2 years after surgery, a 3-cm mass at the site of the anastomosis and dilatation of the Wirsung duct >6 mm in two other patients (2 and 3 years after surgery, respectively). The diagnosis of recurrence was confirmed endoscopically by the presence of a large amount of mucin at the anastomotic site. Cytological examination revealed moderate dysplasia. Opacification of the Wirsung duct after endoscopic retrograde cholangiopancreatography (ERCP) was only possible in one patient in whom an irregular stenosis of the duct was observed.


CONCLUSIONS
Long-term follow-up of the pancreatic remnant after pancreato-duodenectomy for IPMN is better achieved with pancreatico-gastrostomy anastomosis.
Surgical Department, ICMDM Hospital Clínic de Barcelona, Hospital Clínic de Barcelona, Villaroel 170, Barcelona, Spain. lfcruz@clinic.ub.es
Laureano
L
Fernández-Cruz
Miguel-Angel
MA
López-Boado
Joana
J
Ferrer
D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery*; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D019160:Endosonography; D005260:Female; D005773:Gastroscopy; D005774:Gastrostomy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D018365:Neoplasm, Residual; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome