Korean J Hepatobiliary Pancreat Surg.  2013 Aug;17(3):126-130. 10.14701/kjhbps.2013.17.3.126.

Duodenum-preserving pancreatic head resection in benign and low-grade malignant pancreatic tumors

• Lee J
• Lim JH
• Kim SH
• Kim HK
• Park SW
• Chung JB
• Kim KS

• KMID: 1472528
• DOI: http://doi.org/10.14701/kjhbps.2013.17.3.126

Abstract

BACKGROUNDS/AIMS
With development of imaging techniques, pancreatic tumors are being diagnosed more frequently. Applying the standard surgical procedures for pancreatic head tumors, such as pancreaticoduodenectomy and pylorus-preserving pancreaticoduodenectomy may seem too extensive for benign or low-grade malignant pancreas head tumors. Duodenum-preserving pancreatic head resection (DPPHR) has been safely performed in patients with chronic pancreatitis. Recently, DPPHR has been used as a limited surgical procedure to remove benign or low-grade malignant pancreatic head lesions. This study is aimed to evaluate the results of DPPHR in benign or low-grade malignant tumors.
METHODS
Between 2004 and 2012, six patients underwent DPPHR due to benign or low-grade malignant pancreas tumor. We performed this retrospective analysis based on the medical records.
RESULTS
Five of six patients were diagnosed as intraductal papillary mucinous neoplasms. Remaining one patient was diagnosed as solid pseudopapillary neoplasm. The median age of patients was 60.3 (27-75) years, and the median follow-up period was 24 months. The operation time, blood loss and length of stay were 442.5 minutes, 680 ml and 19.2 days, respectively. There was no mortality. Five patients experienced complications including 1 delayed gastric empting, 2 bile duct strictures, 1 pancreatic fistula and 1 duodenal stricture. No recurrence or metastasis was found during follow-up.
CONCLUSIONS
In benign and low-grade malignant lesions of pancreatic head, DPPHR could be alternative to traditional surgery. For applying DPPHR in pancreas tumor, a thorough preoperative examination and utilization of frozen section for sufficient resection margin are required.

Keyword

Pancreatectomy; Duodenum; Organ preservation; Duodenum-preserving pancreatic head resection

MeSH Terms

Bile Ducts
Constriction, Pathologic
Duodenum
Follow-Up Studies
Frozen Sections
Humans
Length of Stay
Neoplasm Metastasis
Organ Preservation
Pancreas
Pancreatectomy
Pancreatic Fistula
Pancreaticoduodenectomy
Pancreatitis, Chronic
Recurrence
Retrospective Studies

Figure

• 

  Fig. 1 A case of solid pseudopapillary neoplasm. (A) A 10 cm-sized, septated, cystic mass in the pancreas head. (B) Duodenum, distal common bile duct and posterior inferior pancreaticoduodenal artery (PDA) were preserved during the duodenum-preserving pancreatic head resection. (C) Atypical mitosis; Tripolar mitosis (arrow) (H-E, ×400). (D) β-catenin was found to be positive for nuclear pattern (×400).

• 

  Fig. 2 Complications presenting duodenal stricture. (A) Ischemic change at the duodenal 2nd portion (arrow). (B) Huge ulcero-infiltrative lesion at duodenum. (C) Duodenal stricture. (D) Pneumatic balloon dilatation of the duodenum.

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