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Duodenum-preserving versus pylorus-preserving pancreatic head resection for benign and premalignant lesions

  • Original article
  • Published:
Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background/purpose

Pylorus-preserving pancreaticoduodenectomy (PPPD) is the treatment of choice for benign or premalignant pancreatic head lesions. Duodenum-preserving pancreatic head resection (DPPHR) has been reported in only 132 patients. This study aimed to compare the long-term results of DPPHR and PPPD.

Methods

Patients who underwent DPPHR or PPPD for benign or borderline disease between 1991 and 2008 were followed up until December 2009 or their death. Endocrine and exocrine pancreatic functions were evaluated at their last follow-up.

Results

Twenty-seven patients underwent DPPHR (Group 1) and 37 PPPD (Group 2). They were followed for a mean of 100 and 135 months, respectively. Group 1 had a higher complication rate (81.5 vs. 40.5%) and pancreatic fistula rate (40.1 vs. 18.9%). Hospital mortality was 0 and 2.7%, respectively. Two patients died 3.3 and 97 months after DPPHR. Significantly more Group 2 patients needed medical treatment for benign cholangitis (P < 0.0001). Insulin-dependent diabetes mellitus was observed in six Group 1 and 15 Group 2 patients (P = 0.077). Ten Group 1 and 21 Group 2 patients are taking pancreatic enzymes (P = 0.003).

Conclusions

DPPHR for benign or premalignant lesions is a difficult procedure with a higher complication rate than PPPD, but was without mortality. Preserving the entire duodenum and a normal biliary tree allows better long-term results.

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Acknowledgments

The authors gratefully acknowledge Tania Lazzarin for helping with the manuscript, and Simona Callegari for helping with data collection.

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Authors and Affiliations

  1. Department of Medical and Surgical Sciences, IV Surgical Clinic, University of Padova, Ospedale Giustinianeo, Via Giustiniani 2, 35128, Padua, Italy

    Sergio Pedrazzoli, Silvio Alen Canton & Cosimo Sperti

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  1. Sergio Pedrazzoli
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  2. Silvio Alen Canton
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  3. Cosimo Sperti
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Correspondence to Sergio Pedrazzoli.

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Pedrazzoli, S., Canton, S.A. & Sperti, C. Duodenum-preserving versus pylorus-preserving pancreatic head resection for benign and premalignant lesions. J Hepatobiliary Pancreat Sci 18, 94–102 (2011). https://doi.org/10.1007/s00534-010-0317-x

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