DUODENUM-PRESERVING RESECTION OF THE PANCREATIC HEAD FOR MUCINOUS DUCTAL ECTASIA WITHOUT OVERT CARCINOMA

BACKGROUND/AIMS: The clinical characteristics of mucinous ductal ectas ia (MDE) of the pancreas without overt carcinoma have not been clarifi ed. To clarify MDE and assess the optimal treatment procedure, includi ng the technique of duodenum-preserving resection of the pancreatic he ad (DpRPH), we studied four patients. METHODOLOGY: Our patients consis ted of three men and one woman, with a mean age of 71 years. The patie nts underwent DpRPH (n = 3) or the pylorus-preserving Whipple procedur e (PpW) (n = 1). Clinicopathological features, postoperative pancreati c function, and technique to preserve duodenal blood flow were studied . RESULTS: All patients had intraductal mucin-hypersecretion and multi locular cysts lined by hyperplastic epithelium. The lesions were locat ed in the uncinate process (n = 3) or head-body (n = 1) of the pancrea s. DpRPH totally removed the lesions in the uncinate process. Of the t hree patients receiving DpRPH, dusky duodenum and a postoperative duod enal ulcer developed in two whose gastroduodenal arteries (GDA) were d ivided, but did not develop in one with undivided GDA. Postoperative g lucose tolerance test and peptide para-aminobenzoic acid test after Dp RPH showed better values than those after PpW. All patients are alive and well 22 to 40 months after surgery. CONCLUSIONS: DpRPH is a new st andard 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.