Early surgery with a ‘fast track’ pathway for periampullary malignancy is associated with an increased rate of pancreatoduodenectomy and reduced costs

Abstract

Background: To estimate results of the organ-preserving pancreatic resections. Methods: Duodenum-preserving pancreatic head resection (DPPHR) was performed in 24 pts with serous (6) and mucinous (6) cystadenomas, branch-duct intraductal papillary mucinous tumors (7), neuroendocrine adenoma (4) and metastatic renal cell carcinoma (1). Alimentary tract reconstruction was performed by pancreatojejunostomy (Roux-en-Y) (21) or pancreatogastrostomy (3). Laparoscopic approach was chosen in 7 cases. Pancreatic head resection combined with segmental duodenectomy (PHRSD) was performed in 22 pts with chronic pancreatitis complicated by duodenal dystrophy (20) and with large serous cystadenoma (2). Alimentary tract reconstruction was performed by duodenoduodenostomy combined with pancreaticojejunostomy and choledochojejunostomy (Roux-en-Y) (7); pancreatogastrostomy and choledochoduodenostomy (13); pancreaticooduodenostomy duct-to-mucosa and choledochoduodenostomy (2). Results: Ischemia of duodenum didn't note in one case. Postoperative complication constituted the following: bile duct stricture (3) and postoperative bleeding (1) in DPPHR, delayed gastric emptying (2) and postoperative bleeding (1) in PHRSD. Newly developed diabetes mellitus occurred in 2 pts. Exocrine pancreatic insufficiency was observed in 2 pts with chronic pancreatitis. There was no hospital mortality. Conclusion: DPPHR is recommended for a benign pancreatic head lesion. PHRSD can be an option for a lesion of the duodenal area and the pancreatic head.