Should we revisit treatment algorithm for the groove pancreatitis? pancreas-preserving duodenal resections vs pancreatoduodenectomy for the cystic dystrophy of the duodenal wall (Groove Pancreatitis)

Abstract

Background: Management of the cystic dystrophy of the duodenal wall (CDDW), or groove pancreatitis (GP), remains controversial. Although pancreatoduodenectomy (PD) is considered as the most suitable operation for CDDW, pancreas-preserving duodenal resection (PPDR) has also been suggested as an alternative for pure form of GP (isolated CDDW). There are no studies comparing PD and PPDR for this disease. Aim: To compare the safety, efficacy, short- and long-term results of PD and PPDR in 85 patients with CDDW. Methods: A retrospective analysis of prospectively collected clinical, radiologic, pathologic, intra- and postoperative data in 85 patients with CDDW (2004-2019) and comparison of safety and efficacy of PD and PPDR was performed. Results: Symptoms: abdominal pain (100%), weight loss (76%), vomiting (30%) and jaundice (18%). The diagnosis was established by CT, MRI, and EUS. CDDW was treated conservatively(n13), by pancreatico- or cystoenterostomies(n8), by duodenum-preserving pancreatic head resections (DPPHR)(n6), by PD(n43), and PPDR(n15) without mortality. Weight gain was significantly higher after PD or PPDR compared to other treatment modalities. Сomplete pain control was achieved after PPDR (93%), PD (83%), DPPHR and draining procedures (18%each). New onset diabetes mellitus (23%) and severe exocrine insufficiency (12%) were not uncommon after PD, but never occurred after PPDR. Conclusion: Pure form of CDDW is a duodenal disease and PD is an overtreatment for it. PPDR is similar in safety and better in efficacy compared to PD in patients with CDDW and may be the optimal operation for the isolated form of CDDW. Early detection of CDDW saves pancreas.