Digestive surgery · 2004
Outcome of duodenum-preserving resection of the head of the pancreas for intraductal papillary-mucinous neoplasm.
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Hirano Satoshi, Kondo Satoshi, Ambo Yoshiyasu, Tanaka Eiichi, Morikawa Toshiaki, Okushiba Shunichi, Katoh Hiroyuki
Аннотация
BACKGROUND: The standard surgical procedure for intraductal papillary-mucinous neoplasm of the pancreatic head is pylorus-preserving pancreatoduodenectomy. A less extensive resection may be justified because most intraductal papillary-mucinous neoplasms are benign or of low-grade malignancy.
AIMS AND METHODS: The outcome of duodenum-preserving pancreatic head resection with preservation of the main bile duct was evaluated retrospectively in 13 patients with a branch-type intraductal papillary-mucinous neoplasm in the head of the pancreas and with a median (range) follow-up of 60.0 (0.3-99.5) months.
RESULTS: Post-operative complications included anastomotic leakage (n=3), bile duct perforation (n=1), intra-abdominal bleeding (n=3), delayed gastric emptying (n=2) and death (n=2). All the resection margins were clear of tumour on histological examination. Ten of 11 patients maintained over 90% of their pre-operative body weight. Glucose tolerance improved in 4 of 11 evaluable patients, was unchanged in 6 and worsened in 1 patient. Biliary scintigraphy showed that bile flow was delayed compared with that before surgery (8.8 +/- 1.1 vs. 19.6 +/- 4.6 min; p = 0.03). Neither recurrence nor metastasis was observed.
CONCLUSION: The results of duodenum-preserving pancreatic head resection for branch duct-type intraductal papillary-mucinous neoplasm were satisfactory and provided a good quality of life.
AIMS AND METHODS: The outcome of duodenum-preserving pancreatic head resection with preservation of the main bile duct was evaluated retrospectively in 13 patients with a branch-type intraductal papillary-mucinous neoplasm in the head of the pancreas and with a median (range) follow-up of 60.0 (0.3-99.5) months.
RESULTS: Post-operative complications included anastomotic leakage (n=3), bile duct perforation (n=1), intra-abdominal bleeding (n=3), delayed gastric emptying (n=2) and death (n=2). All the resection margins were clear of tumour on histological examination. Ten of 11 patients maintained over 90% of their pre-operative body weight. Glucose tolerance improved in 4 of 11 evaluable patients, was unchanged in 6 and worsened in 1 patient. Biliary scintigraphy showed that bile flow was delayed compared with that before surgery (8.8 +/- 1.1 vs. 19.6 +/- 4.6 min; p = 0.03). Neither recurrence nor metastasis was observed.
CONCLUSION: The results of duodenum-preserving pancreatic head resection for branch duct-type intraductal papillary-mucinous neoplasm were satisfactory and provided a good quality of life.