Long-term Results of Pylorus-Preserving Pancreatoduodenectomy for Chronic Pancreatitis

Martin, Ronald F.; Rossi, Ricardo L.; Leslie, Kenneth A.

doi:10.1001/archsurg.1996.01430150025004

Cited by 90 publications

(55 citation statements)

References 14 publications

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“…Resection of the distal bile duct in patients undergoing PD requires a bilio-enteric anastomosis, which increases the risk of ascending cholangitis and subsequent intrahepatic abscesses [17] . Following PD, the incidence of diabetes mellitus varies between 15% and 40% [18,19] . It can be noted in reports of recent papers that there is unchanged endocrine and exocrine pancreatic function following segmental pancreatic resection [20][21][22] .…”

Section: Discussionmentioning

confidence: 99%

Experience of limited pancreatic head resection for management of branch duct intraductal papillary mucinous neoplasm in a single center

Paik¹,

Choi²

2009

WJG

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AIM:To share our surgical experience and the outcome of limited pancreatic head resection for the management of branch duct intraductal papillary mucinous neoplasm (IPMN). METHODS: Between May 2005 and February 2008, nine limited pancreatic head resections (LPHR) were performed for IPMN of the pancreatic head. We reviewed the nine patients, retrospectively. RESULTS:Tumor was located in the uncinate process of the pancreas in all nine patients. Three patients had stents inserted in the main pancreatic duct due to injury. The mean size of tumor was 28.4 mm. Postoperative complications were found in five patients: 3 pancreatic leakages, a pancreatitis, and a duodenal stricture. Pancreatic leakages were improved by external drainage. No perioperative mortality was observed and all patients are recorded alive during the mean follow-up period of 17.2 mo. CONCLUSION:In selected patients after careful evaluation, LPHR can be used for the treatment of branch duct type IPMN. In order to avoid pancreatic ductal injury, pre-and intra-operative definite localization and careful operative techniques are required.

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Section: Discussionmentioning

confidence: 99%

Experience of limited pancreatic head resection for management of branch duct intraductal papillary mucinous neoplasm in a single center

Paik¹,

Choi²

2009

WJG

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“…The current reported incidence of bleeding complications varies from 1% to 10%. [12][13][14]18,23,24,26,27,29,32,34,[53][54][55] A number of series from high-volume centers report a very low bleeding rate (Ͻ3%). 13,14,27,53 The incidence of bleeding complications appears to be related to the type of resection.…”

Section: Hemorrhagementioning

confidence: 99%

“…It has clearly been demonstrated that major relief of pain is achieved after standard PD, pylorus-preserving PD, and duodenum-preserving pancreatic head resection 7,8,[12][13][14][15][16]18,19,23,24 ( Table 9). Studies comparing the PD (standard and pyloruspreserving PD) to the Beger procedure indicate a superiority of the duodenum-preserving procedure.…”

Section: What Is the Clinical Effectiveness Of Pancreatoduodenectomy mentioning

confidence: 99%

“…During long-term follow-up (Ͼ6 months), most of the studies report a significant increase in body weight, ranging from 2 to 8 kg. 14,15,23 Two randomized studies showed better weight gain and lower rates of exocrine insufficiency after the duodenumpreserving Beger procedure when compared to the standard and pylorus-preserving PD.…”

Section: What Is the Clinical Effectiveness Of Pancreatoduodenectomy mentioning

confidence: 99%

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Evidence-Based Pancreatic Head Resection for Pancreatic Cancer and Chronic Pancreatitis

Schäfer¹,

Müllhaupt²,

Clavien³

2002

Annals of Surgery

192

113

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ObjectiveTo review the current status of pancreatoduodenectomy for pancreatic cancer and chronic pancreatitis using evidencebased methodology. Summary Background DataDespite improved results of pancreatoduodenectomy over the recent years, the reputation of the Whipple procedure and its main modifications has remained poor. In addition, the current status of newer modifications of standard pancreatoduodenectomy is still under debate. MethodsMedline search and manual cross-referencing were performed to identify all relevant articles for classification and analysis according to their quality of evidence. The search was limited to articles published between 1990 and 2001. ResultsThe mortality rate of pancreatoduodenectomy has declined to less than 5% for chronic pancreatitis and 3% to 8% for pancreatic cancer. In contrast, overall morbidity rates remain high, ranging between 20% and 70%. Delayed gastric emptying represents almost half of all complications. The overall 5-year survival rate for patients with pancreatic cancer remains poor, ranging between 5% and 15%, with a median survival of 13 to 17 months. Mortality and morbidity are not related to the type of pancreatoduodenectomy; however, patients with pancreatic cancer tend to be at increased risk for complications. Extended lymph node dissection and portal vein resection can be performed with similar mortality and morbidity rates as standard procedures, but without apparent survival benefits in the long term. Major relief of pain is achieved in 70% to 100% of patients with chronic pancreatitis. ConclusionsPancreatoduodenectomy and its main modifications are safe and effective treatment modalities, especially in experienced centers with a high patient volume. For chronic pancreatitis, surgical resection provides major relief of pain and thus increased quality of life. Overall survival for patients with pancreatic cancer is determined predominantly by the pathology within the resected specimen.

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“…However, Frey's procedure, which is technically easier, can be performed with significantly lower morbidity. As mortality of resectional procedures like Whipple (68,71), Longmire-Traverso (48,72,73) or Beger (48) (47,51,66,67) has dropped to nearly nil in experienced centers, the argument of an increased mortality cannot be used any further in favor of drainage operations. However, significantly lower periand postoperative morbidity still favors the extended draining procedures.…”

Section: Results Of Surgery In Chronic Pancreatitismentioning

confidence: 99%

Customized Surgical Strategy in Chronic Pancreatitis

Mann

Izbicki

2005

Scand J Surg

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Despite major advances in the management of patients with chronic pancreatitis, yet the disease remains an enigmatic process of uncertain pathogenesis, unpredictable clinical course, and unclear treatment. In most of the cases intractable pain is the main indication for surgical intervention. Furthermore complications related to adjacent organs, endoscopically not permanently controlled pancreatic pseudocysts, ductal pathology, conservatively intractable internal pancreatic fistula or suspected malignancy also require surgery. The ideal surgical approach should address all these problems -tailoring the various therapeutic options to meet the individual patient's needs. In our opinion, the ideal procedure for chronic pancreatitis is the duodenum preserving pancreatic head resection in terms of an extended drainage procedure, were the extent of the pancreatic head resection may be tailored to the morphology of the pancreatic gland, thus allowing a tailored concept (to resect and/or drain as much as necessary but as little as possible). Looking at the present data, there is no need to transsect the pancreatic axis above the portal vein. If portal vein thrombosis is present, an extended drainage procedure is mandatory without transsection of the neck of the pancreas.

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Long-term Results of Pylorus-Preserving Pancreatoduodenectomy for Chronic Pancreatitis

Cited by 90 publications

References 14 publications

Experience of limited pancreatic head resection for management of branch duct intraductal papillary mucinous neoplasm in a single center

Experience of limited pancreatic head resection for management of branch duct intraductal papillary mucinous neoplasm in a single center

Evidence-Based Pancreatic Head Resection for Pancreatic Cancer and Chronic Pancreatitis

Customized Surgical Strategy in Chronic Pancreatitis

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