Surgery for mucin-producing pancreatic tumor

Abstract

Background/aims: There is a diversity of mucin-producing tumors of the pancreas, including benign adenoma, malignant intraductal papillary carcinoma and invasive papillary carcinoma. However, there has been little discussion of appropriate techniques for surgically treating these tumors.

Methodology: From August 1981 to December 1997, surgery was performed on 24 patients with mucin-producing pancreatic tumors (18 cases were malignant and 6 were benign). The surgical techniques which were used, the results of surgery, and the post-operative course of the patients are discussed.

Results: Surgical resection was possible in 23 patients and included: 4 cases of total pancreatectomy; 1 case of pancreaticoduodenectomy (Whipple's procedure); 1 case of Whipple's procedure with a transverse colectomy; 13 cases of pylorus-preserving pancreaticoduodenectomy (PPPD); 2 cases of duodenum-preserving pancreatic head resection (DPPHR); 1 case of resection of the posterior segment of the pancreas (posterior segmentectomy); and, 1 case of resection of the medial segment of the pancreas (medial segmentectomy). Surgical resection was also used for 17 (94.4%) of the 18 patients with malignant tumor. There were no fatalities during or immediately following surgery. One patient developed transient duodenal stenosis after DPPHR. The 5-year survival rate after surgical resection was 68.4% for the 17 patients with malignant tumor. Mucus leaked from the pancreatic duct into the operating field of 1 patient during pancreatectomy. This patient died 7 months after surgery from a tumor metastasis of the thoracic mediastinal lymph nodes and peritoneal seeding. This episode illustrates the high risk associated with leakage of pancreatic duct mucus into the operating field. The longest surviving patient, 13 years and 11 months after total pancreatectomy, has good health and shows no signs of recurrence.

Conclusions: The prognosis for surgically resectable mucin-producing pancreatic tumors is better than that for invasive pancreatic duct carcinoma. When treating mucin-producing pancreatic tumors surgically, techniques which allow preservation of pancreatic and gastroenteric functions should be selected when possible. These techniques include PPPD, DPPHR and pancreatic segmentectomy. A total pancreatectomy should only be selected in cases where cancer has invaded the entire pancreas (especially when cancer has invaded the duct within the pancreatic head, through the tail). It may also be used when residual cancer cells have been detected by intra-operative pathological examination at the distal stump of the pancreas. During surgery with any technique, leakage of pancreatic duct mucus into the operating field must be avoided.