Surgical strategy for main pancreatic duct-type intraductal papillary mucinous neoplasm of the pancreas.

BACKGROUND/AIMS Although surgical resection is recommended for all main duct-type intraductal papillary mucinous neoplasms (IPMNs), controversies remain over the precise surgical strategy that should be adopted. This study thus aimed to investigate the appropriate surgical strategy for main duct IPMNs. METHODOLOGY We retrospectively evaluated 46 patients with main duct-type IPMNs who underwent surgical resection at a single center between 1991 and 2010. RESULTS Only 1 patient underwent total pancreatectomy (TP). Three patients underwent repeated pancreatectomy; TP was performed after distal pancreatectomy (DP) in 2 of these patients and after pylorus-preserving pancreaticoduodenectomy (PPPD) in the remaining patient. There current histology indicated minimally invasive carcinoma in all 3 of these patients. Among the 6 patients who died in the present study, no deaths occurred due to local recurrence of the remnant pancreas. CONCLUSIONS Total pancreatectomy should be considered very selectively in the presence of a malignant lesion spreading to the whole pancreas.