Pancreas-preserving total duodenectomy: a systematic review

Abstract

Introduction: The management of the pancreas in patients with duodenal trauma or duodenal tumors remains a controversial issue. Pancreas-preserving total duodenectomy is a procedure that requires a meticulous surgical technique as well as a thorough and detailed knowledge of peripancreatic anatomy. The most common indication is familial duodenal adenomatous polyposis. The aims of this study are to carry out a systematic review of the literature on the indications for pancreas-preserving total duodenectomy, to highlight the risks and benefits, and to demonstrate the significant reduction in mortality compared with other aggressive surgical techniques. Methods: Regulated systematic literature review following PRISMA recommendations of all studies published in PubMed, Embase, and Cochrane library with no limits on year of initial publication until 31 May 2019. A total of 30 articles describing 211 patients that met the inclusion criteria were chosen. Results: The mean age was 48 years. Seventy-five per cent of patients presented an initial surgical indication of familial adenomatous polyposis (98% Spigelman stages III-IV). The mean operating time was 329 minutes, and mean intraoperative bleeding 412 ml. Postoperative morbidity rate was 49.7% (76% with Clavien-Dindo < IIIa) and mortality rate 1.4%. The mean hospital stay was 22 days. Overall survival at 1-3-5 years was > 97.8%. Conclusions: Pancreas-preserving total duodenectomy is indicated for patients with benign and premalignant duodenal lesions without involvement of the pancreatic head. It is a safe and feasible procedure that reduces risks and increases peri-operative benefits compared to other aggressive surgical techniques. Mortality is below 1.5%.