Total parenchymal pancreatectomy preserving the duodenum, choledochus and spleen for widespread intraductal papillary mucinous neoplasm: report of a case.

For patients with benign or low malignant diseases of the pancreas, several organ-preserving surgical techniques of pancreatectomy have been presented for localized lesions. In cases of widespread or multifocal neoplasms of the pancreas, however, it is difficult to treat with this limited pancreatectomy because of a possible risk of residual dysplastic foci. We herein report a patient with widespread intraductal papillary mucinous neoplasm treated successfully with total parenchymal pancreatectomy. A 73-year-old man was diagnosed as main duct intraductal papillary mucinous neoplasm. A papillary tumor was located in the body of the pancreas, and intraepithelial spreading reached almost the end of the pancreas tail and nearly over the midpoint of the pancreas head. We performed total parenchymal pancreatectomy, an initial surgical procedure in which almost all parenchyma of the pancreas was resected but the duodenum, the common bile duct and the spleen were preserved and no reconstruction was needed. The postoperative course was uneventful and his blood glucose level had been controlled carefully with insulin formulation. No recurrence was observed during over the 30-month follow-up period. For susceptible patients, total parenchymal pancreatectomy may provide clinical benefits of significant radicality and less invasiveness than classical total pancreatectomy.