Surgical Management of Intraductal Papillary Mucinous Tumors of the Pancreas

Open Access
Publisher Website
Google Scholar
Abstract
INTRADUCTAL PAPILLARY mucinous tumors of the pancreas (IPMTP) were first described by Ohhashi and colleagues1,2 in 1980 and 1982. Since then, an increasing number of cases have been reported, mainly in Japan3-18 but also in Europe19-25 and the United States.26-35 The pathological and clinical features of IPMTP are entirely different from the characteristics of pancreatic duct cell carcinoma. These tumors consist of papillary projections of the pancreatic duct epithelium with massive mucin production oozing from the papilla of Vater and provoking dilatation of the main pancreatic duct or subbranches. The tumor is characterized by a longitudinal spread into the pancreatic duct system with frequent malignant transformation. The prognosis, which is usually good, depends on the presence of invasive carcinoma. The tumor generally develops in the head of the pancreas but is often diffuse or multifocal. Because of the potential of IPMTP for malignant growth, radical surgical resection is mandatory; preoperative investigations are unable to accurately discriminate between benign and malignant forms of the disease.14,20,26 We report our experience of 13 patients with IPMTP, focusing on several aspects of perioperative surgical strategy. These include (1) the routine use of frozen section of the transection line; (2) intraoperative endoscopic staged biopsies of the Wirsung duct for perioperative disease staging; and (3) pancreaticogastric anastomosis after pancreatoduodenectomy for postoperative long-term assessment of the pancreatic stump.