LONG-TERM MORPHOLOGICAL-CHANGES OF REMNANT PANCREAS AND BILIARY TREE AFTER PANCREATICODUODENECTOMY ON CT

Background. Despite the increasing number of long-term survivors after pancreatoduodenectomy, little is known about morphological appearance of the remnant pancreas or the biliary system after surgery. Methods. To evaluate long-term morphological changes of the remnant pancreas a nd biliary tree after pancreatoduodenectomy, computed tomograms obtain ed at the time of surgery and more than 2 years after operation were r eviewed in 19 Japanese patients. Results. Two to three years after sur gery, parenchymal atrophy of the remnant pancreas occurred in 9 (56%) of 16 patients without atrophy at the time of surgery, Three patients who had had parenchymal atrophy preoperatively showed no change after surgery. Of 10 patients with a dilated pancreatic duct preoperatively, 8 (80%) patients demonstrated a decline in ductal size, while the oth er 2 showed persistent ductal dilatation, Of 9 patients with a normal- sized pancreatic duct preoperatively, 2 patients (22%) developed ducta l dilatation after surgery, and the other 7 showed no change. In 4 (57 %) of 7 patients,vith a dilated hepatic duct preoperatively dilatation was reduced after surgery, whereas it persisted in the remaining 3, O nly one (8%) of 12 patients with a nondilated biliary tree preoperativ ely showed ductal dilatation 6 months following surgery. Pneumobilia w as revealed in 13 (68%) of 19 patients by the follow-up examinations. Conclusions. Surgeons should be aware of these changes in morphology o f the remnant pancreas and biliary tree after pancreatectoduodenectomy .