Duodenum-preserving resection of the pancreatic head for mucinous ductal ectasia without overt carcinoma.

BACKGROUND/AIMS: The clinical characteristics of mucinous ductal ectasia (MDE) of the pancreas without overt carcinoma have not been clarified. To clarify MDE and assess the optimal treatment procedure, including the technique of duodenum-preserving resection of the pancreatic head (DpRPH), we studied four patients.

METHODOLOGY

Our patients consisted of three men and one woman, with a mean age of 71 years. The patients underwent DpRPH (n=3) or the pylorus-preserving Whipple procedure (PpW) (n=1). Clinicopathological features, postoperative pancreatic function, and technique to preserve duodenal blood flow were studied.

RESULTS

All patients had intraductal mucin-hypersecretion and multilocular cysts lined by hyperplastic epithelium. The lesions were located in the uncinate process (n=3) or head-body (n=1) of the pancreas. DpRPH totally removed the lesions in the uncinate process. Of the three patients receiving DpRPH, dusky duodenum and a postoperative duodenal ulcer developed in two whose gastroduodenal arteries (GDA) were divided, but did not develop in one with undivided GDA. Postoperative glucose tolerance test and peptide para-aminobenzoic acid test after DpRPH showed better values than those after PpW. All patients are alive and well 22 to 40 months after surgery.

CONCLUSIONS

DpRPH is a new standard for MDE. During DpRPH, preservation of the GDA and the superior portion of the pancreatic head is recommended to maintain an adequate duodenal blood flow.