title: Surgical strategy for main pancreatic duct-type intraductal papillary mucinous neoplasm of the pancreas.
abstract: OBJECTIVE
  Although surgical resection is recommended for all main duct-type intraductal papillary mucinous neoplasms (IPMNs), controversies remain over the precise surgical strategy that should be adopted. This study thus aimed to investigate the appropriate surgical strategy for main duct IPMNs.
  
  
  METHODS
  We retrospectively evaluated 46 patients with main duct-type IPMNs who underwent surgical resection at a single center between 1991 and 2010.
  
  
  RESULTS
  Only 1 patient underwent total pancreatectomy (TP). Three patients underwent repeated pancreatectomy; TP was performed after distal pancreatectomy (DP) in 2 of these patients and after pylorus-preserving pancreaticoduodenectomy (PPPD) in the remaining patient. There current histology indicated minimally invasive carcinoma in all 3 of these patients. Among the 6 patients who died in the present study, no deaths occurred due to local recurrence of the remnant pancreas.
  
  
  CONCLUSIONS
  Total pancreatectomy should be considered very selectively in the presence of a malignant lesion spreading to the whole pancreas.
authors.affiliation: Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan. tkuroki-gi@umin.ac.jp
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kuroki
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Adachi
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Ono
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tanaka
authors.forename: Amane
authors.initials: A
authors.lastname: Kitasato
authors.forename: Mitsuhisa
authors.initials: M
authors.lastname: Takatsuki
authors.forename: Susumu
authors.initials: S
authors.lastname: Eguchi
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome