Middle segment-preserving pancreatectomy for metachronous intraductal papillary mucinous neoplasm after pancreatoduodenectomy: a case reportReport as inadecuate




Middle segment-preserving pancreatectomy for metachronous intraductal papillary mucinous neoplasm after pancreatoduodenectomy: a case report - Download this document for free, or read online. Document in PDF available to download.

Surgical Case Reports

, 3:28

First Online: 14 February 2017Received: 14 November 2016Accepted: 10 February 2017

Abstract

Total pancreatectomy has occasionally been performed to treat patients with multiple lesions such as intraductal papillary mucinous neoplasm IPMN or patients who have undergone repeated pancreatic resection. However, deficiencies of the exocrine and endocrine functions worsen patients’ quality of life. Recently, there have been several case reports citing middle segment-preserving pancreatectomy MSPP as a safe procedure and beneficial with respect to preservation of the exocrine and endocrine functions. We herein report the case of a patient who underwent MSPP for repeat pancreatectomy for IPMN and in whom a favorable outcome was achieved. The patient, a 70-year-old man, was diagnosed with branch duct-type IPMN BD-IPMN with worrisome features in the pancreatic head and a single cyst in the pancreatic tail, during a preoperative examination of early gastric cancer. Pancreatoduodenectomy was performed for BD-IPMN in the pancreatic head and gastric cancer. A histopathological examination showed an intraductal papillary mucinous adenoma IPMA with mild-moderate atypia. During the follow-up, the size of the cystic lesion in the pancreatic tail and the diameter of the main pancreatic duct were gradually increasing. Therefore, at 2 years and 6 months after surgery, distal pancreatectomy with preservation of the spleen namely MSPP was performed. The pancreatic resection margin was histologically negative. The length and volume of the remnant pancreas were approximately 6 cm and 10 ml, respectively. A histopathological examination showed an IPMA. The patient had no diarrhea or weight loss without digestive enzymes and maintained favorable glucose tolerance without oral hypoglycemic agents or insulin. He has showed no evidence of new lesions in the remnant pancreas at 3 years of follow-up after the last surgery.

KeywordsMiddle segment-preserving pancreatectomy Intraductal papillary mucinous neoplasm AbbreviationsBD-IPMNBranch duct-type IPMN

CTComputed tomography

DMDiabetes mellitus

DPDistal pancreatectomy

ERCPEndoscopic retrograde cholangiopancreatography

EUSEndoscopic ultrasonography

IPMAIntraductal papillary mucinous adenoma

IPMNIntraductal papillary mucinous neoplasm

MPDMain pancreatic duct

MRCPMagnetic resonance cholangiopancreatography

MSPPMiddle segment-preserving pancreatectomy

PDPancreatoduodenectomy

QOLQuality of life

TPTotal pancreatectomy

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Author: Mihoko Yamada - Teiichi Sugiura - Yukiyasu Okamura - Takaaki Ito - Yusuke Yamamoto - Ryo Ashida - Katsuhiko Uesaka

Source: https://link.springer.com/article/10.1186/s40792-017-0306-2







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