Background/Purpose. A total pancreatectomy (TP) is rarely performed to treat invasive ductal carcinoma of the pancreas due to the associated markedly impaired quality of life and poor prognosis after the resection. Intraductal papillary-mucinous neoplasm (IPMN) of the pancreas is characterized by an extensive intraductal spread and a favorable outcome even when presenting at an invasive stage. We herein reappraise the role of a pylorus-preserving total pancreatectomy (PPTP) as a viable alternative pancreatic resection modality for borderline and malignant IPMN. Methods. A total of five patients with IPMN underwent PPTP and their clinical follow-up data were reviewed. Results. TP was performed due to recurrent IPMN in the remnant pancreas after distal pancreatectomy in three patients and due to massive involvement of the entire pancreas in the others. All patients were treated by the pylorus-preserving method, while the spleen was also preserved in one patient. The surgical margins were negative and no metastasis to the resected lymph nodes was evident based on histological examinations. One patient underwent a re-operation due to postoperative intra-abdominal bleeding while another patient required tube-drainage for left pleural effusion. Three out of four patients who underwent PPTP with a splenectomy experienced postoperative gastric ulcer which were controlled by medication. One patient was died due to suicide at 16 months after PPTP. All others were doing well without recurrence at from 62 months to 127 months after PPTP. Conclusions. PPTP is therefore considered to be indicated as an effective treatment for borderline or malignant IPMN with extensive involvement when the patient’s condition permits in order to obtain a complete resection of the IPMN.
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