Preservation of arterial arcades during duodenum-preserving total pancreatic head resection for intraductal papillary tumor.

Duodenum-preserving pancreatic head resection with preservation of the bile duct or without, has been performed in cases of benign or low-grade malignancies, such as intraductal papillary tumors, of the head of the pancreas. However, the selection of the patients, the area of resection in the head of the pancreas, and the operative procedures for the preservation of the pancreaticoduodenal vessels has not been realized among surgeons to apply duodenum-preserving pancreatic head resection as a radical treatment of intraductal papillary tumors. In our experience, duodenum-preserving pancreatic head resection can be applied in the majority of the patients with the branch type of intraductal papillary tumors, and it is necessary to resect completely the head of the pancreas to avoid tumor remnant and pancreatic fistula from the remaining pancreatic rim. Therefore, we modified it to include a total resection of the pancreatic head and the preservation of both anterior and posterior arterial arcades, due to the multiformity of the location of the tumor, the variation of the branch duct in the head of the pancreas, the closure of the minor papilla in some patients, and the unbalanced development of the arterial arcades of the pancreaticoduodenal region. We performed a duodenum-preserving total pancreatic head resection with preservation of the bile duct and the both anterior- and posterior-arterial arcades for 6 patients with the normal gland involving intraductal papillary tumors. The blood flow in this organ was based on the blood supply from both preserved arterial arcades, and the duodenum had retained good color, and the postoperative results were satisfactory.