Inferior head resection of the pancreas for intraductal papillary mucinoustumors

BACKGROUND: Patients with intraductal papillary mucinous tumor have a favor able prognosis after surgical treatment. When this neoplasm is located in t he head of the pancreas, resection has conventionally required pancreatoduo denectomy. Although pancreatoduodenectomy can now be performed with a low m ortality rate, morbidity still occurs frequently, METHODS: Between November 1982 and January 1999, 38 intraductal papillary m ucinous tumors of the pancreas were resected at the Chiba University Hospit al. Seven patients (18%) underwent inferior head resection of the pancreas. In this preliminary study, the operative technique is presented, and its e fficacy in improvement of quality of life is evaluated. RESULTS: Patients with intraductal papillary mucinous tumor underwent resec tion with no perioperative mortality, After discharge from hospital, 6 pati ents who underwent inferior head resection were still alive without recurre nt disease after a median follow-up of 3 years. However, 1 patient develope d peritoneal dissemination and died 18 months after inferior head resection , Patients had regained 98% of preoperative weight 1 year after inferior he ad resection. N-benzoyl-L-tyrosyl-p-amino-benzoic acid (BT-PABA) excretion test showed the same value before (73%) and after (73%) inferior head resec tion (n = 7). Pancreatic fistulas occurred more frequently after inferior h ead resection (38%), but the incidence of major complications was similar b etween inferior head resection and other types of pancreatic head resection , CONCLUSIONS: Pancreatic function was well preserved, and patients regained 98% of preoperative weight after inferior head resection of the pancreas. T he authors concluded that the limited involvement of intraductal papillary mucinous tumors enables the surgeons to perform inferior head resection of the pancreas. (C) 2000 by Excerpta Medica, Inc.