Whole stomach and spleen preserving total pancreatectomy: a new surgical technique for pancreatic cancer.

Total pancreatectomy has been used to treat both benign and malignant diseases of the pancreas. The procedure of total pancreatectomy for invasive pancreatic cancer usually includes distal gastrectomy and splenectomy to prevent ischemic changes due to decreased blood supply. In this report, it was introduced a new technique of total pancreatectomy for invasive pancreatic cancer preserving both the whole stomach and spleen. The patient was a 61 year old man. Preoperative computed tomography (CT) showed a mass of tumor, measuring 23x18x25mm, located in the pancreatic head. It was tried, initially to perform pylorus-preserving pancreatoduodenectomy (PPPD). Repeated frozen section examination of the pancreatic stumps, however, revealed persistent cancer infiltration to the distal pancreas. Therefore, we altered the planned PPPD to total pancreatectomy preserving the whole stomach and spleen with severing both the splenic artery and vein at their origins. The postoperative course was uneventful. Enhanced CT following surgery showed sufficient blood supply to the whole stomach and spleen without any congestive changes of blood flow. This method is considered safe and useful for patients with both benign and malignant disease of the pancreas.