Top

Published in:

01-02-2007

Repeated Pancreatectomy after Pancreatoduodenectomy

Authors: Fumihiko Miura, Tadahiro Takada, Hodaka Amano, Masahiro Yoshida, Takahiro Isaka, Naoyuki Toyota, Keita Wada, Kenji Takagi, Kenichoro Kato

Published in: Journal of Gastrointestinal Surgery | Issue 2/2007

Abstract

Background

When pancreatic duct dilatation is found in the patient having undergone pancreatoduodenectomy (PD), observation is chosen in most cases. Similarly, recurrent tumor in the remnant pancreas of invasive ductal carcinoma (IDC) of the pancreas is seldom indicated for resection. We have aggressively performed repeated pancreatectomy for these cases and obtained good results.

Methods

Repeated pancreatectomy after PD was performed for three types of circumstances: (1) pancreatodigestive anastomotic stricture; (2) neoplasm after intraductal papillary mucinous neoplasm (IPMN); and (3) recurrence of IDC of the pancreas.

Results

Resection of anastomosis and reanastomosis was performed for pancreatodigestive stricture in four patients. Symptoms derived from pancreatitis in three patients resolved by the second operation and did not recur during follow-up. None of the four patients required pancreatic enzyme substitution because of clinically overt malabsorption, and the defecation frequency of the four patients was within twice a day. Mild diabetes mellitus has been identified in only one patient who had diabetes mellitus before the second surgery. Completion pancreatectomy and pancreatic tail resection was performed for recurrence in two patients and IDC in one patient, respectively, after PD for IPMN. Intrapancreatic recurrences of IPMN in two patients existed in the main pancreatic ducts. As CT revealed pancreatic duct dilatation but not intraductal tumors, recurrences were not correctly diagnosed before the second operation. Completion pancreatectomy was performed for recurrence of IDC in two patients. One patient who underwent completion pancreatectomy for recurrence of IDC survived 66/44 months after the first/second operation.

Conclusion

Repeated pancreatectomy should be performed for patients with pancreatodigestive anastomotic stricture to preserve remnant pancreatic function and for patients with neoplasm or pancreatic duct dilatation after PD for IPMN, and repeated pancreatectomy for recurrence of IDC might be indicated for selected patients.

Miura F, Takada T, Amano H, Yoshida M, Furui S, Takeshita K. Diagnosis of pancreatic cancer. HPB 2006;8:208–213.

Yamaguchi K, Tanaka M, Chijiiwa K, Nagakawa T, Imamura M, Takada T. Early and late complications of pylorus-preserving pancreatoduodenectomy in Japan 1998. Journal of Hepato–biliary–Pancreatic Surgery 1999;6:303–311.PubMed

Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 1993;217:430–435 (discussion 435–438).PubMedCrossRef

Niiyama H, Yamaguchi K, Shimizu S, Yokohata K, Chijiiwa K, Yonemasu H, et al. Pancreatic carcinoma in remnant pancreas after pancreatectomy for mucinous cystadenoma. European Journal of Gastroenterology and Hepatology 1998;10:703–707.PubMed

Eriguchi N, Aoyagi S, Imayama H, Okuda K, Hara M, Fukuda S, et al. Resectable carcinoma of the pancreatic head developing 7 years and 4 months after distal pancreatectomy for carcinoma of the pancreatic tail. Journal of Hepato–biliary–Pancreatic Surgery 2000;7:316–320.PubMed

Wada K, Takada T, Yasuda H, Amano H, Yoshida M. A repeated pancreatectomy in the remnant pancreas 22 months after pylorus-preserving pancreatoduodenectomy for pancreatic adenocarcinoma. Journal of Hepato–biliary–Pancreatic Surgery 2001;8:174–178.PubMed

Takamatsu S, Ban D, Irie T, Noguchi N, Kudoh A, Nakamura N, et al. Resection of a cancer developing in the remnant pancreas after a pancreaticoduodenectomy for pancreas head cancer. J Gastrointest Surg 2005;9:263–269.PubMedCrossRef

Alberti K, Hockaday T. Diabetes mellitus. In Weatherall D, Ledingham J, Warrell D. eds. Oxford textbook of medicine, 2nd ed. New York: Oxford Medical Publications, 1987, pp 51–101.

Sobin L, Wittekind C. TNM Classification of Malignant Tumours, 6th ed. New York: Wiley-Liss, 2002.

10.

Suda K, Mogaki M, Oyama T, Matsumoto Y. Histopathologic and immunohistochemical studies on alcoholic pancreatitis and chronic obstructive pancreatitis: Special emphasis on ductal obstruction and genesis of pancreatitis. Am J Gastroenterol 1990;85:271–276.PubMed

11.

Bradley EL, III. Pancreatic duct pressure in chronic pancreatitis. Am J Surg 1982;144:313–316.PubMedCrossRef

12.

Jalleh RP, Aslam M, Williamson RC. Pancreatic tissue and ductal pressures in chronic pancreatitis. Br J Surg 1991;78:1235–1237.PubMedCrossRef

13.

Hashimoto N, Fujiwara H, Nomura H, Ohyanagi H. In vivo evaluation of long-term patency of pancreaticoenterostomy after Whipple operation. Hepatogastroenterology 2000;47:866–868.PubMed

14.

Hall RI, Rhodes M, Isabel-Martinez L, Kelleher J, Venables CW. Pancreatic exocrine function after a sutureless pancreatico-jejunostomy following pancreaticoduodenectomy. Br J Surg 1990;77:83–85.PubMedCrossRef

15.

Kono T, Okazumi S, Mochizuki R, Ootsuki K, Shinotou K, Matsuzaki H, et al. Clinical application of (11)C-methionine positron emission tomography for evaluation of pancreatic function. Pancreas 2002;25:20–25.PubMedCrossRef

16.

Monill J, Pernas J, Clavero J, Farre A, Morales A, Gonzalez M, et al. Pancreatic duct after pancreatoduodenectomy: Morphologic and functional evaluation with secretin-stimulated MR pancreatography. AJR American Journal of Roentgenology 2004;183:1267–1274.PubMed

17.

Tiscornia OM, Dreiling DA. Recovery of pancreatic exocrine secretory capacity following prolonged ductal obstruction. Bicarbonate and amylase response to hormonal stimulation. Ann Surg 1966;164:267–270.PubMedCrossRef

18.

Jordan GL Jr, Strugm BS, Crowder WE. Current status of pancreatojejunostomy in the management of chronic pancreatitis. Am J Surg 1977;133:46–51.PubMedCrossRef

19.

Prinz RA, Kaufman BH, Folk FA, Greenlee HB. Pancreaticojejunostomy for chronic pancreatitis. Two- to 21-year follow-up. Arch Surg 1978;113:520–525.PubMed

20.

Prinz RA, Greenlee HB. Pancreatic duct drainage in 100 patients with chronic pancreatitis. Ann Surg 1981;194:313–320.PubMedCrossRef

21.

Warshaw AL. Conservation of pancreatic tissue by combined gastric, biliary, and pancreatic duct drainage for pain from chronic pancreatitis. Am J Surg 1985;149:563–569.PubMedCrossRef

22.

Amano H, Takada T, Ammori BJ, Yasuda H, Yoshida M, Uchida T, et al. Pancreatic duct patency after pancreaticogastrostomy: Long-term follow-up study. Hepatogastroenterology 1998;45:2382–2387.PubMed

23.

Idezuki Y, Goetz FC, Lillehei RC. Late effect of pancreatic duct ligation on beta cell function. Am J Surg 1969;117:33–39.PubMedCrossRef

24.

Kasahara K, Yamashita Y, Ishibashi H, Fukumoto T, Tenmoku S, Kashii A, et al. Factors influencing insulin secretion after pancreatoduodenectomy. Jpn J Surg 1987;17:445–454.PubMedCrossRef

25.

Chari ST, Yadav D, Smyrk TC, DiMagno EP, Miller LJ, Raimondo M, et al. Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology 2002;123:1500–1507.PubMedCrossRef

26.

Sho M, Nakajima Y, Kanehiro H, Hisanaga M, Nishio K, Nagao M, et al. Pattern of recurrence after resection for intraductal papillary mucinous tumors of the pancreas. World J Surg 1998;22:874–878.PubMedCrossRef

27.

Cuillerier E, Cellier C, Palazzo L, Deviere J, Wind P, Rickaert F, et al. Outcome after surgical resection of intraductal papillary and mucinous tumors of the pancreas. Am J Gastroenterol 2000;95:441–445.PubMedCrossRef

28.

Christensen JA, Fletcher JG, Fidler JL, Wold PB, Binstock AJ, Smyrk T, et al. Intraductal papillary mucinous neoplasms of the pancreas: CT patterns of recurrence and multiobserver performance in detecting recurrent neoplasm after surgical resection. AJR American Journal of Roentgenology 2004;183:1367–1374.PubMed

29.

Sugiyama M, Abe N, Tokuhara M, Masaki T, Mori T, Takahara T, et al. Magnetic resonance cholangiopancreatography for postoperative follow-up of intraductal papillary-mucinous tumors of the pancreas. Am J Surg 2003;185:251–255.PubMedCrossRef

30.

Yamaguchi K, Ohuchida J, Ohtsuka T, Nakano K, Tanaka M. Intraductal papillary-mucinous tumor of the pancreas concomitant with ductal carcinoma of the pancreas. Pancreatology 2002;2:484–490.PubMedCrossRef

31.

Nakagohri T, Kinoshita T, Konishi M, Inoue K, Takahashi S. Survival benefits of portal vein resection for pancreatic cancer. Am J Surg 2003;186:149–153.PubMedCrossRef

32.

D’Amato A, Gentili V, Santella S, Boschetto A, Pronio A, Montesani C. Carcinoma of the pancreatic remnant developing after pancreaticoduodenectomy for adenocarcinoma of the head of pancreas. Chir Ital 2002;54:539–544.PubMed

Title: Repeated Pancreatectomy after Pancreatoduodenectomy
Authors: Fumihiko Miura
Tadahiro Takada
Hodaka Amano
Masahiro Yoshida
Takahiro Isaka
Naoyuki Toyota
Keita Wada
Kenji Takagi
Kenichoro Kato
Publication date: 01-02-2007
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 2/2007
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-006-0026-6

At a glance: The STEP trials

Springer Medicine

Repeated Pancreatectomy after Pancreatoduodenectomy

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2007

An Ileal Endometrioma: Of Carcinoids and Cadherin

Gastric Adenocarcinoma: Reduction of Perioperative Mortality by Avoidance of Nontherapeutic Laparotomy

Transanal Endoscopic Microsurgery (TEM) Resection of Rectal Tumors

Stapled Transanal Rectal Resection (STARR) for Rectocele

What to Expect in the Excluded Stomach Mucosa after Vertical Banded Roux-en-Y Gastric Bypass for Morbid Obesity

Partial Portal Vein Ligation Plus Thioacetamide: A Method to Obtain a New Model of Cirrhosis and Chronic Portal Hypertension in the Rat