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Pylorus- and spleen-preserving total pancreatoduodenectomy with resection of both whole splenic vessels: feasibility and laparoscopic application to intraductal papillary mucin-producing tumors of the pancreas

Abstract

Background

Total pancreatectomy is recommended for intraductal papillary mucinous tumors with widespread involvement of the entire pancreas. Organ-preserving and minimally invasive surgery should be applied in benign and borderline pancreatic lesions.

Methods

Pylorus- and spleen-preserving total pancreatoduodenectomy (PpSpTPD) with segmental resection of both splenic vessels was attempted for five patients. The technique was based on the concepts of two surgical procedures: pylorus-preserving pancreatoduodenectomy and distal pancreatectomy with segmental resection of splenic vessels (“extended” Warshaw’s procedure).

Results

Three patients underwent laparoscopic-assisted PpSpTPD and two underwent open surgery. No mortality was noted. Short-term follow-up (median, 28 months) suggested that all patients tolerated the insulin therapy and showed relatively good nutritional status. Only minimal to moderate perigastric fundal varices were noted without gastrointestinal bleeding.

Conclusions

PpSpTPD with segmental resection of both splenic vessels is feasible and safe. Even a minimally invasive approach can be indicated in selected patients.

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Acknowledgments

A part of this paper was presented under the title of “Laparoscopic pancreatectomy: techniques and indication” at the 23rd Meeting of the Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo (Japan), June 8–10, 2011. The authors thank Dong-Soo Jang (Medical illustrator, Yonsei University College of Medicine, Department of Research Affairs) for the illustrations and Jou-Hua Chen (Medical University of Silesia School of Medicine, Katowice, Poland) for her valuable devotion and contribution in preparing an English narration in the video.

Disclosures

Drs. Choi SH, Kang CM, Hwang HK, Yoon CI, and Lee WJ have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Chang Moo Kang.

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Choi, S.H., Hwang, H.K., Kang, C.M. et al. Pylorus- and spleen-preserving total pancreatoduodenectomy with resection of both whole splenic vessels: feasibility and laparoscopic application to intraductal papillary mucin-producing tumors of the pancreas. Surg Endosc 26, 2072–2077 (2012). https://doi.org/10.1007/s00464-011-2113-3

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Keywords

  • Intraductal papillary mucinous tumor
  • Total pancreatectomy
  • Pylorus-preserving
  • Spleen-preserving