Duodenum-preserving subtotal or total pancreatic head resection and total pancreatic head resection with segmental duodenectomy in tumors and chronic pancreatitis

Abstract

Objectives: To estimate Results of the duodenum-preserving pancreatic head resections as alternatives to pancreaticoduodenectomy. Material & Methods: 135 pts duodenum-preserving subtotal pancreatic head resection (DPSPHR), duodenum-preserving total pancreatic head resection (DPTPHR) and total pancreatic head resection combined with segmental duodenectomy (TPHRSD). DPSPHR (Beger’s or Kimura’s method) was performed in 83 pts with a preoperative diagnosis of chronic pancreatitis in case of suspected cancer. Alimentary tract reconstruction after DPSPHR was performed by pancreatojejunostomy (Roux-en-Y) with the distal and proximal stump of the pancreas (Beger’s procedure) (n=67) or with the distal stump of the pancreas only (Kimura’s procedure) (n=16). DPTPHR (n=25) was performed pts with a preoperative diagnosis of serous (n=7) and mucinous (n=6) cystadenomas, IPMN-BD (n=7), neuroendocrine adenoma (n=4) and metastatic renal cell carcinoma (n=1). Alimentary tract reconstruction after DPTPHR was performed by pancreatojejunostomy (Roux-en-Y) (n=22) and pancreatogastrostomy (n=3). Laparoscopic approach was chosen in 7 cases from all DPTPHR. TPHRSD (n=27) was performed in chronic pancreatitis complicated by duodenal dystrophy (n=23), large serous cystadenoma (n=3), neuroendocrine adenoma (n=1). Alimentary tract reconstruction was performed by duodenoduodenostomy combined with pancreaticojejunostomy and choledochojejunostomy (n=8); pancreatogastrostomy and choledochoduodenostomy (n=15); pancreaticooduodenostomy duct-to-mucosa and choledochoduodenostomy (n=4). Results: Surgical parameters, postoperative complications, endocrine function, exocrine function, and long-term outcomes were evaluated. No differences were noted in the mean operation time and estimated blood loss between this procedures and pylorus-preserving pancreaticoduodenectomy. Ischemia of duodenum didn’t note in one case of DPSPHR or DPTPHR. Postoperative complication constituted the following: bile duct stricture (n=4), postoperative bleeding (n=7), delayed gastric emptying (n=2). Newly developed diabetes mellitus occurred in 12 pts. Exocrine pancreatic insufficiency was observed in 2 pts. There was no hospital or long-term mortality. Conclusions: Periampullary lesions could be treated with DPSPHR, DPTPHR and TPHRSD, which could substitute for pylorus-preserving pancreaticoduodenectomy.