title: Pylorus- and spleen-preserving total pancreatoduodenectomy with resection of both whole splenic vessels: feasibility and laparoscopic application to intraductal papillary mucin-producing tumors of the pancreas.
abstract: BACKGROUND
  Total pancreatectomy is recommended for intraductal papillary mucinous tumors with widespread involvement of the entire pancreas. Organ-preserving and minimally invasive surgery should be applied in benign and borderline pancreatic lesions.
  
  
  METHODS
  Pylorus- and spleen-preserving total pancreatoduodenectomy (PpSpTPD) with segmental resection of both splenic vessels was attempted for five patients. The technique was based on the concepts of two surgical procedures: pylorus-preserving pancreatoduodenectomy and distal pancreatectomy with segmental resection of splenic vessels ("extended" Warshaw's procedure).
  
  
  RESULTS
  Three patients underwent laparoscopic-assisted PpSpTPD and two underwent open surgery. No mortality was noted. Short-term follow-up (median, 28 months) suggested that all patients tolerated the insulin therapy and showed relatively good nutritional status. Only minimal to moderate perigastric fundal varices were noted without gastrointestinal bleeding.
  
  
  CONCLUSIONS
  PpSpTPD with segmental resection of both splenic vessels is feasible and safe. Even a minimally invasive approach can be indicated in selected patients.
authors.affiliation: Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Choi
authors.forename: Ho Kyoung
authors.initials: HK
authors.lastname: Hwang
authors.forename: Chang Moo
authors.initials: CM
authors.lastname: Kang
authors.forename: Chang Ik
authors.initials: CI
authors.lastname: Yoon
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Lee
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000601:surgery*; D059351:Organ Sparing Treatments / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011708:Pylorus / Q000601:surgery; D013154:Spleen / Q000601:surgery; D016896:Treatment Outcome