Ann Hepatobiliary Pancreat Surg.  2025 May;29(2):157-167. 10.14701/ahbps.24-214.

Short-term and long-term outcomes of pancreas preserving total duodenectomy: A case series from a single center with 13 years’ experience and complimentary meta-analysis

• Hammoda M
• Hajibandeh S
• Al-Sarireh B

• KMID: 2568264
• DOI: http://doi.org/10.14701/ahbps.24-214

Abstract

Backgrounds/Aims
To determine short-term and long-term outcomes after pancreas preserving total duodenectomy (PPTD).
Methods
A case series and a complementary meta-analysis were conducted. All patients with (pre)neoplastic lesions of duodenum who underwent PPTD in a tertiary center for pancreatic surgery between May 2009 and October 2022 were included for the case series. All studies in the literature with a sample size of 10 or more patients reporting outcomes of PPTD were included for the meta-analysis.
Results
A total of 439 patients (18 from case series and 421 from literature) were analyzed. Clavien-Dindo (CD) I complications in 2.9% (95% confidence interval [CI] 0.6%–5.2%), CD II complications in 21.1% (14.6%–27.6%), CD III complications in 18.1% (9.3%–26.9%), CD IV complications in 2.7% (0.5%–4.9%), and CD V complications in 2.2% (0.2%–4.2%) of patients were found. Probabilities of overall survival and recurrence-free survival at 15 years were 87% and 86%, respectively. There was no significant difference in the risk of mortality (odds ratio [OR]: 0.82, p = 0.830), total complications (OR: 0.77, p = 0.440), postoperative pancreatic fistula (OR: 0.43, p = 0.140), delayed gastric emptying (OR: 0.70, p = 0.450), or postoperative bleeding (OR: 0.97, p = 0.960) between PPTD and pancreaticoduodenectomy.
Conclusions
PPTD is safe and feasible for (pre)neoplastic lesions of duodenum not involving the pancreatic head. The risk of severe complications (CD > III) is low and long-term outcomes are favorable. Whether PPTD provides advantages over more radical techniques in terms of long-term outcomes remains controversial and requires further research.

Keyword

Duodenectomy; Complications; Survival

Figure

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  Fig. 1 Flow diagram of this study.

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  Fig. 2 Kaplan–Meier survival curve for overall survival (OS) (A) and recurrence-free survival (RFS) (B) after pancreas-preserving total duodenectomy. Probability of OS was 87% at 5 years, 87% at 10 years, and 87% at 15 years. Probability of RFS was 94% at 5 years, 86% at 10 years, and 86% at 15 years.

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  Fig. 3 Forest plots for pooled risks of (A) Clavien-Dindo I complications; (B) Clavien-Dindo II complications; (C) Clavien-Dindo III complications; (D) Clavien-Dindo IV complications; and (E) Clavien-Dindo V complications. Ev/Trt, events/total; CI, confidence interval.

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  Fig. 4 Forest plot for comparison of outcomes between pancreas preserving total duodenectomy (PPTD) and pancreaticoduodenectomy (PD). M-H, Mantel–Haenszel; CI, confidence interval.

Reference

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