Outcome of duodenum-preserving resection of the head of the pancreas for intraductal papillary-mucinous neoplasm

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. Copyright (C) 2004 S. Karger AG, Basel.