Abstract
BackgroundThere is no standard surgical method for treating pancreatic head tumors with fat replacement of the pancreatic body and tail. Total pancreatectomy procedures are usually performed to excise pancreatic head tumors and lead to endocrine function loss and subsequent development of diabetes. We present a rare case where the adipose tissue was preserved during pancreaticoduodenectomy in a patient with a solid pseudopapillary neoplasm and fat-replaced pancreatic body and tail.Case presentationContrast-enhanced computed tomography scans of a 43-year-old man revealed a tumor measuring approximately 3 cm in size with calcification in the pancreatic head. Magnetic resonance cholangiopancreatography showed that the pancreatic ducts in the body and tail were completely disrupted. Furthermore, endoscopic ultrasonography showed no pancreatic parenchyma in the body and tail of the pancreas, with disruption in the main pancreatic duct. Endoscopic ultrasonography-guided fine-needle aspiration led to the final pathological diagnosis of a solid pseudopapillary neoplasm, and laparoscopic total pancreatectomy was performed. However, intraoperative findings indicated that the tumor was located in the pancreatic head. Pancreatic parenchyma was not observed in the pancreatic body or tail, as it had been completely replaced with adipose tissue. Nevertheless, the shape of the pancreas was identifiable. Therefore, pancreaticoduodenectomy was performed to transect parenchyma at the pancreatic neck, while preserving the adipose tissue present in the pancreatic body. The main pancreatic duct could not be identified at the cut surface. Therefore, we performed modified Blumgart-style pancreaticojejunostomy to cover the cut end instead of reconstructing the pancreatic duct. The patient was discharged on postoperative day 12 without complications and is being followed-up as an outpatient. His fasting blood sugar and hemoglobin A1c levels according to the National Glycohemoglobin Standardization Program reports were within normal limits, indicating that the endocrine function (insulin secretion ability) was preserved during the 1.5 years following surgery.ConclusionsIn patients with pancreatic head tumors, pancreaticoduodenectomy that preserves fat-replaced pancreatic body and tail tissues can preserve postoperative endocrine function.
Highlights
There is no standard surgical method for treating pancreatic head tumors with fat replacement of the pancreatic body and tail
We report on a novel case in which adipose tissue was preserved during pancreaticoduodenectomy (PD) in a patient with a solid pseudopapillary neoplasm (SPN) and fat-replaced pancreatic body and tail
The patient was discharged on postoperative day 12 without complications. He is being followed-up 1.5 years after the surgery. His fasting blood sugar and hemoglobin A1c (HbA1c) levels according to the National Glycohemoglobin Standardization Program (NGSP) reports were within the normal limits (HbA1c NGSP, preoperatively, 5.5%; 3 months postoperatively, 5.7%), indicating that endocrine function was preserved
Summary
Studies have reported that approximately 60% of patients with congenital aplasia in the body and tail of the pancreas develop diabetic complications [15]. The loss of pancreatic tissue in the body and tail of the pancreas was noted in most patients who underwent TP; adipose tissue replacement of pancreatic tissue was not observed in any of these patients. Patients who underwent PD had no remnant pancreatic tissue, but did have adipose tissue, with the remaining Langerhans islets having replaced the lost pancreatic tissue. These results suggested that the Langerhans islets were retained in cases with adipose tissue replacement, which preserved endocrine function; the patients did not develop diabetes. We believed that performing PD with retention of fat-replaced pancreatic body and tail tissues in patients with pancreatic head tumors can preserve postoperative endocrine function.
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