title: Head dorsal pancreatectomy: an alternative to the pancreaticoduodenectomy for not enucleable benign or low-grade malignant lesions.
abstract: BACKGROUND
  Head dorsal pancreatectomy (HDP) is a segmental pancreatic resection, conservative variant of total dorsal pancreatectomy, applied to preserve the functional pancreatic parenchyma as an alternative to pancreaticoduodenectomy in not enucleable benign or low-grade malignant lesions. The absences of biliary and gastrointestinal resection/reconstruction are the other advantages of the technique.
  
  
  METHODS
  We reported a case of HDP performed in a female 39-year-old patient for a neuroendocrine tumour of the dorsal portion of the pancreatic head.
  
  
  RESULTS
  The superior mesenteric vein was dissected from the pancreatic neck. The pancreas was transected at the left margin of the superior mesenteric vein. After identification and mobilisation of gastroduodenal artery and the anterior superior pancreatico-duodenal artery, the head dorsal segment was dissected stepwise from the duodenal wall toward the common bile duct plane; the dissection of the pancreatic parenchyma was completed along the anterior surface of the common bile duct. An end-to-side duct-to-mucosa pancreaticojejunostomy was performed. The main pancreatic duct in the ventral segment on the dissection parenchymal surface was ligated. With the inclusion of this case, there are a total of 3 cases involving resection of the dorsal portion of the pancreatic head reported in the literature.
  
  
  CONCLUSIONS
  HDP seems to be technically feasible and safe for not enucleable benign or low-grade malignant neoplasms involving the dorsal pancreatic head. However, due to the singularity of the indications and the few cases reported in the literature, further studies are needed to validate the technique.
authors.affiliation: Department of Surgery, Division of General Surgery A, Unit of Hepato-Pancreatico-Biliary-Surgery, University of Verona Medical School, Verona, Italy. Electronic address: calogero.iacono@univr.it.
authors.forename: Calogero
authors.initials: C
authors.lastname: Iacono
authors.affiliation: Department of Surgery, Division of General Surgery A, Unit of Hepato-Pancreatico-Biliary-Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ruzzenente
authors.affiliation: Department of Surgery, Division of General Surgery A, Unit of Hepato-Pancreatico-Biliary-Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Conci
authors.affiliation: Department of Surgery, Division of General Surgery A, Unit of Hepato-Pancreatico-Biliary-Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Xillo
authors.affiliation: Department of Surgery, Division of General Surgery A, Unit of Hepato-Pancreatico-Biliary-Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guglielmi
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D060787:Neoplasm Grading; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy
keywords: Benign and low-grade malignant lesions; Conservative pancreatectomy; Pancreatic neurendocrine tumor; Pancreatic surgery; Parenchyma sparing pancreatectomy; Segmental pancreatic resection