Nihon Geka Gakkai zasshi
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Nihon Geka Gakkai zasshi · Jun 2003
Review[Duodenum-preserving total pancreatic head resection and pancreatic head resection with segmental duodenostomy].
A duodenum-preserving pancreatic head resection (DPPHR) was first reported by Beger et al. in 1980. However, its application has been limited to chronic pancreatitis because of it is a subtotal pancreatic head resection. In 1990, we reported duodenum-preserving total pancreatic head resection (DPTPHR) in 26 cases. ⋯ When performing DPTPHR, the surgeon should ensure adequate duodenal blood supply. Avoidance of duodenal ischemia is very important in this operation, and thus it is necessary to maintain blood flow in the posterior pancreatoduodenal artery and to preserve the mesoduodenal vessels. Postoperative pancreatic functional tests reveal that DPTPHR is superior to PPPD, including PHSRD, because the entire duodenum and duodenal integrity is very important for postoperative pancreatic function.
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Nihon Geka Gakkai zasshi · Jun 2003
Review[Anatomy of the head of the pancreas and various limited resection procedures for intraductal papillary-mucinous tumors of the pancreas].
The surgical anatomy, as well as the results of anatomic investigation of the pancreas, are reviewed. Anatomic descriptions, which are useful not only for ordinary pancreaticoduodenectomy or distal pancreatectomy, but also for limited resection of the pancreas for low-grade malignancy such as mucin-producing tumors or cystic lesions of the pancreas, are also provided. The fusion fascia of the head of the pancreas is called the "fusion fascia of Treitz" and that of the body and tail of the pancreas is termed the "fusion fascia of Toldt." The fusion fascia is histologically composed of a loose connective tissue membrane. ⋯ On the other hand, distal pancreatectomy that preserves both the splenic artery and vein and the spleen is steadily gaining popularity. Although this procedure is somewhat complicated, it is not technically difficult and can be safely performed by any surgeon. This procedure is indicated for some cases with chronic pancreatitis and IPMT.
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Nihon Geka Gakkai zasshi · Jun 2003
[Strategy for surgical treatment of intraductal papillary-mucinous tumors].
The prognosis of malignant intraductal papillary mucinous tumors of the pancreas (IPMTs) should be considered more favorable than that of ordinary pancreatic ductal carcinoma. However, the preoperative diagnosis of malignancy is extremely difficult in IPMT. IPMT with a main pancreatic duct of less than 7 mm, or cystic lesion of less than 30 mm (branched type), or intramural nodule tumor of less than 4 mm, should be observed without performing surgery and followed carefully. ⋯ Which procedure should be selected or performed? A radical operation should be performed with lymph node dissection if a preoperative diagnosis of malignancy is made. If cancer cannot be ruled out in an IPMT, a function-preserving procedure, such as pylorus-preserving pancreaticoduodenectomy, pancreatic head resection with second-portion duodenectomy, segmental resection, partial resection, or spleen-preserving distal pancreatectomy should be selected, and one of these procedures should be carried out with group I lymph node dissection. The greatest challenge in IPMT is making the diagnosis of benign or malignant and selecting the most appropriate treatment.