For patients with benign or low malignant diseases of the pancreas, several organ-preserving surgical techniques of
pancreatectomy have been presented for localized lesions. In cases of widespread or multifocal
neoplasms of the pancreas, however, it is difficult to treat with this limited
pancreatectomy because of a possible risk of residual dysplastic foci. We herein report a patient with widespread intraductal papillary
mucinous neoplasm treated successfully with total parenchymal
pancreatectomy. A 73-year-old man was diagnosed as main duct intraductal papillary
mucinous neoplasm. A papillary
tumor was located in the body of the pancreas, and intraepithelial spreading reached almost the end of the pancreas tail and nearly over the midpoint of the pancreas head. We performed total parenchymal
pancreatectomy, an initial
surgical procedure in which almost all parenchyma of the pancreas was resected but the duodenum, the common bile duct and the spleen were preserved and no reconstruction was needed. The postoperative course was uneventful and his
blood glucose level had been controlled carefully with
insulin formulation. No recurrence was observed during over the 30-month follow-up period. For susceptible patients, total parenchymal
pancreatectomy may provide clinical benefits of significant radicality and less invasiveness than classical total
pancreatectomy.