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.