Significant positive impact of duodenum‐preserving pancreatic head resection on the prevention of postoperative nonalcoholic fatty liver disease and acute cholangitis

Abstract

Aim: This study aimed to compare the incidence of postoperative nonalcoholic fatty liver disease (NAFLD), postoperative cholangitis, and fibrosis-4 (FIB)-4 index in patients who underwent duodenum-preserving pancreatic head resection (DPPHR) and pancreaticoduodenectomy (PD) for low-grade malignant tumors and verify the usefulness of DPPHR in preventing the occurrence of these disorders. Methods: This retrospective study included 70 patients who underwent PD (n = 39) and DPPHR (n = 31) between 2006 and 2018 for benign or low-grade malignant tumors. The present study compared the preoperative background, cumulative incidence of postoperative NAFLD and cholangitis, and other biochemical markers, including the FIB-4 index. Subanalysis by propensity score matching (PSM) analysis was conducted to minimize treatment selection bias.Results: In terms of the cumulative incidence of NAFLD, the 5-y incidence was significantly lower in the DPPHR group than in the PD group both before (10% vs 38%, P = .002) and after (13% vs 38%, P = .008) matching. Multivariate analyses identified DPPHR as the only independent preventive factor for postoperative NAFLD (hazard ratio: 0.160, 95% confidence intervals: 0.034-0.76, P = .021). The 5-y cumulative incidence of postoperative cholangitis was significantly higher in the PD group than in the DPPHR group before (51% vs 3%, P < .001) and after (49% vs 4%, P < .001) matching.The FIB-4 index at 12 mo postoperatively was significantly better in the DPPHR group than in the PD group (1.45 vs 2.35, P = .006) before matching. Conclusion:Preservation of the duodenum and bile duct may contribute to preventing long-term postoperative NAFLD and cholangitis, and liver fibrosis for benign or low-grade malignant pancreatic head tumors. K E Y W O R D S duodenum-preserving pancreatic head resection, FIB-4 index, pancreaticoduodenectomyThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Clinical feasibility of duodenum-preserving pancreatic head resection for neuroendocrine tumors of the pancreatic head as intermediate procedure between enucleation and pancreaticoduodenectomy

“…However, Kato et al compared the incidence of short-term complications in patients with low-grade malignant tumors treated with DPPHR and PD, and reported no difference in the incidence of short-term complications such as pancreatic stula. Moreover, they also reported a signi cantly lower incidence of postoperative cholangitis in the long term [11]. Horiguchi et al also reported that postoperative endocrine and exocrine functions were signi cantly preserved in the DPPHR group compared to the PD group [7].…”

“…The surgical technique for DPPHR was described in a previous study [11]. Brie y, it involves: 1) Dissection of gastric and duodenocolic ligaments without Kocher's maneuver to preserve the drainage veins from duodenum.…”

“…In addition, compared to subtotal stomach-preserving pancreatoduodenectomy (SSPPD), gastrointestinal reconstruction in DPPHR is simpler and more physiologic, leading to lower incidence of eating disorder [10]. Moreover, since the common bile duct, duodenum, and Vater's papilla are preserved, there is no re ux of intestinal uid into the bile duct, and therefore, the incidence of postoperative cholangitis is also signi cantly reduced [11,12].…”

Short-term clinical outcomes of laparoscopic duodenum-preserving pancreatic head resection for the management of pancreatic-head cystic neoplasms

“…The study found that the cause of NAFLD after PD was malnutrition [ 19 ]. Kato et al [ 20 ] reported that the serum albumin level in the DPPHR group were significantly better than that in the PD group (4.2 vs. 3.9; P = 0.003), the prognostic nutritional index of the DPPHR group was better (albeit the difference was not significant), and the incidence of postoperative NAFLD in the DPPHR group was also lower than that in the PD group. As LDPPHR can better maintain the continuity of the stomach-duodenum-bile duct, LDPPHR offers more advantages than LPD in terms of postoperative gastrointestinal function recovery and nutritional status.…”

Recent trends in organ‐preserving pancreatectomy: Its problems and clinical advantages compared with other standard pancreatectomies

“…7,[73][74][75][76][77][78][79] Regarding the comparison of short-term postoperative complications between DPPHR (n = 21) and PD (n = 19), Horiguchi et al 7 found no significant differences in operative time, blood loss, complications, or hospital stay. Kato et al 80 also reported no significant difference in the frequency of postoperative complications, including pancreatic fistula, when DPPHR (n = 34) was compared with subtotal preserving pancreaticoduodenectomy (SSPPD) (n = 41).…”