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Published on: September 24, 2020
Dorsal pancreatectomy: an embryology-based resection
Olivier Scatton1, Alain Sauvanet, Dominique Cazals-Hatem
1Department of Digestive Surgery, Hôpital Beaujon, AP-HP, University Paris VII, 100 Boulevard du Général Leclerc, 92118 Clichy-Cedex, France.
Abstract:
In a 45-year-old man with acute pancreatitis and recent onset of diabetes mellitus, intraductal papillary mucinous neoplasm (IPMN) associated with pancreas divisum was found. There were no arguments for an invasive component in the IPMN lesions, which seemed to involve nearly all the dorsal pancreas. Resection of only the dorsal pancreas was performed with division of the pancreas at the internal side of the duodenum and at the anterior edge of the common bile duct. The gastroduodenal artery was preserved resulting in good vascularization of both common bile duct and proximal duodenum. Postoperative course was marked by a transient pancreatic fistula. Definitive pathological examination revealed noninvasive IPMN involving several branch ducts and partially the cephalic dorsal duct, with an 8 mm tumor-free segment from the transection level. Twelve months after resection, the patient had normal gastrointestinal function with neither clinical exocrine insufficiency nor uncontrolled diabetes. Postoperative magnetic resonance imaging revealed no signs of recurrence in the ventral pancreas. In patients with pancreas divisum, dorsal pancreatectomy can be proposed for noninvasive IPMN involving only the dorsal pancreas to avoid drawbacks of total duodenopancreatic resection.
Insights
Dorsal pancreatectomy is a viable surgical option for noninvasive intraductal papillary mucinous neoplasm (IPMN) in patients with pancreas divisum. This approach avoids extensive resection while maintaining normal pancreatic function.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Endocrinology
Background:
- Intraductal papillary mucinous neoplasm (IPMN) is a premalignant cystic neoplasm of the pancreas.
- Pancreas divisum is a common congenital anomaly where the pancreatic ducts fail to fuse during development.
- Acute pancreatitis and new-onset diabetes mellitus can be presenting symptoms of pancreatic neoplasms.
Observation:
- A 45-year-old male presented with acute pancreatitis and recent-onset diabetes mellitus.
- Imaging revealed an intraductal papillary mucinous neoplasm (IPMN) associated with pancreas divisum, involving predominantly the dorsal pancreas without evidence of invasion.
- The patient underwent a limited dorsal pancreatectomy, preserving the gastroduodenal artery.
Findings:
- Pathological examination confirmed noninvasive IPMN involving branch ducts and the cephalic dorsal duct, with a tumor-free margin.
- The patient experienced a transient pancreatic fistula postoperatively.
- Twelve months post-surgery, the patient exhibited normal gastrointestinal function, no exocrine insufficiency, and controlled diabetes, with no signs of recurrence on MRI.
Implications:
- Dorsal pancreatectomy can be a safe and effective organ-sparing procedure for selected cases of noninvasive IPMN in the dorsal pancreas, especially in the context of pancreas divisum.
- This approach may prevent the morbidity associated with total pancreaticoduodenectomy.
- Preserving pancreatic function is crucial for maintaining gastrointestinal and endocrine homeostasis post-resection.
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