Abstracts
1997 Digestive Disease Week

Two clinical types of mucin hypersecreting tumor of the pancreas and comparison of the results of surgical management.

M Kobari, H Shimamura, S Egawa, K Amikura, M Sunamura, S Matsuno. The First Department of Surgery, Tohoku University School of Medicine, Sendai, Japan.

The mucin hypersecreting tumor of the pancreas are histologically classified as intraductal tumors of the pancreas (IDT) in General Rules for the Study of Pancreatic Cancer by Japan Pancreas Society and are clinically divided into two types, main duct type (MDT) in which tumor locate in main pancreatic duct and branch duct type (BDT) in which tumor locate in branch duct. This time, clinical characteristics of these two types of IDT and the results of surgical management are compared between the two types. Subjects and Methods: Pancreatic resections were done for 29 patients out of 30 patients diagnosed as having IDT. There were 13 patients in MDT and 17 patients in BDT. One patient has been followed without operation in BDT. Results: In both types the number of males patients were three times more than female patients. Mean ages of patients in both types were about 64 years old. The patients of both types suffered from epigastric pain for more than 2 years. The chief complaints were epigastric pain in 75% for MDT and 60% for BDT. Both the history of acute pancreatitis and diabetes mellitus were more for patients in MDT (67% and 83%) compared with patients in BDT (21% and 29%). In ERCP or tumor imaging diagnosis, typical finding for MDT was diffuse dilatation of main pancreatic duct with filling defects. For BDT, cystic dilatation with filling defects or clusters of small cysts were characteristic findings. In MDT, 4 patients underwent total pancreatectomy (TP), 2 patients pancreatoduodenectomy (PD), and 7 patients distal pancreatectomy (DP) because 77% of tumors located in the body of pancreas. Histologically 92% of tumors in this type were diagnosed as carcinoma. In BDT, 10 PDs, 5 DPs, and one segmental resection were done as 65% of tumors located in the head. Histological diagnosis of these tumors were carcinoma in 5 and adenoma in 11. In spite of careful resective procedure, the tumor cells remained at the cut end of the pancreas in 6 (46%) of MDT and in 4 (24%) of BDT. The survival rate of BDT was statistically higher than that of MDT. Five year survival rates were 90% for BDT and 47% for MDT. Conclusion: This two clinical types of IDT of the pancreas should be distinguished preoperatively because the pathological characteristics and the prognosis are so different. A good prognosis can be expected in IDT. However, total pancreatectomy is the operation of choice when the tumor is located in main pancreatic duct (MDT).