Outcome of Duodenum-Preserving Resection of the Head of the Pancreas for Intraductal Papillary-Mucinous Neoplasm

Abstract

Background: The standard surgical procedure for intraductal papillary-mucinous neoplasm of the pancreatic head is pylorus-preserving pancreatoduodenectomy. A less extensive resection may be justified because most intraductal papillary-mucinous neoplasms are benign or of low-grade malignancy. Aims and Methods: The outcome of duodenum-preserving pancreatic head resection with preservation of the main bile duct was evaluated retrospectively in 13 patients with a branch-type intraductal papillary-mucinous neoplasm in the head of the pancreas and with a median (range) follow-up of 60.0 (0.3–99.5) months. Results: Post-operative complications included anastomotic leakage (n = 3), bile duct perforation (n = 1), intra-abdominal bleeding (n = 3), delayed gastric emptying (n = 2) and death (n = 2). All the resection margins were clear of tumour on histological examination. Ten of 11 patients maintained over 90% of their pre-operative body weight. Glucose tolerance improved in 4 of 11 evaluable patients, was unchanged in 6 and worsened in 1 patient. Biliary scintigraphy showed that bile flow was delayed compared with that before surgery (8.8 ± 1.1 vs. 19.6 ± 4.6 min; p = 0.03). Neither recurrence nor metastasis was observed. Conclusion: The results of duodenum-preserving pancreatic head resection for branch duct-type intraductal papillary-mucinous neoplasm were satisfactory and provided a good quality of life.

Organ-preserving surgery for benign lesions and low-grade malignancies of the pancreatic head: A matched case-control study

“…Delayed gastric emptying is a clinical scenario extensively studied following PD; however, some authors suggest that PS can be accompanied by DGE. 13,18,22 In fact, duodenal ischemia is one of the main concerns in DPPHR. According to some investigators, movement of the duodenum-pancreas or Kocher's maneuver could underlie postoperative morbidity, [23][24][25][26] which is probably related to cutting the retroperitoneal blood vessels with consequent duodenal ischemia.…”

Duodenum-preserving total and partial pancreatic head resection for benign tumors – Systematic review and meta-analysis

“…Post-prandial CCK secretion indicated a significant postoperative difference after Whipple-type PD, whereas pre-and postoperative values were the same in the DPPHRt group [34]. Determining the postoperative onset of phase III gastric motility of the MMC, indicated that the onset of a physiological transport motility of the upper GI-tract was significantly prolonged after pylorus-preserving PD compared to DPPHRt with preservation of the duodenum [26].…”

Duodenum-preserving total pancreatic head resection for cystic neoplasm—a limited but cancer-preventive procedure

“…Using the subtotal pancreatic head resection technique, the risk of reoccurrency of the cystic lesion is increased. In regard to postoperative morbidity and hospital mortality, the application of duodenum-preserving total pancreatic head resection has favorable results in comparison to results after partial pancreaticoduodenectomy [5,[38][39][40][41][42][43][44][45][46][47][48][49]. In regard to longterm outcome, completion of extirpation of the lesion and exclusion of an invasive cancer in the cyst are the most determining factors.…”