Duodenum-Preserving Pancreatic Head Resection: Preliminary Report on Indications and Techniques

Abstract

Objectives To define the optimal indications for and operative method of duodenum-preserving pancreatic head resection. Methods: The clinicopathologic data, surgical procedures, complications, and clinical outcomes of all patients treated with duodenum-preserving pancreatic head resections at our hospital were reviewed. Results: Six patients (four with chronic pancreatitis and two with cystic pancreatic head tumor) were treated with duodenum-preserving pancreatic head resection (DPPHR). No patient suffered any complication attributable to duodenal ischemia. No tumor recurrence was noted in the two patients with pancreatic head tumor during the follow-up period of 32 and 30 months, respectively. Dramatic pain relief was noted in all of the four patients with chronic pancreatitis during a median follow-up period of 18 months (range: 6 to 27 months). Conclusions: with methods of cutting the pancreas along the line of the anterior superior pancreatico-duodenal artery (ASPD) without doing Kocher's maneuver, duodenum-preserving pancreatic head resection can be safely performed. Duodenum-preserving pancreatic head resection is best indicated for chronic pancreatitis patients with an inflammatory head mass but without obstruction of the common bile duct or duodenum. For patients with pancreatic head cystic tumor, we try to apply this method of operation instead of the Whipple operation, and the results have been satisfactory. However, we should emphasize that duodenum-preserving pancreatic head resection should not be done until frozen section proves benignancy and free section margins.