Duodenum-Preserving Pancreatic Head Resection



Duodenum-preserving pancreatic head resection (DPPHR) was first described in the 1970s by Beger in Germany to treat patients with chronic pancreatitis [1, 2]. In 1988, Takada performed the first duodenum-preserving total pancreatic head resection (DPPHRt) to treat benign or low-grade malignant tumors of the pancreatic head by preserving the duodenum with its intact blood supply from the pancreatic duodenal arterial arcade [3, 4]. The increasing use of high resolution CT/MR and endoscopic ultrasonography has increased the diagnostic and accuracy rates of cystic tumors of the pancreatic head in recent years. Most tumors are benign but with a risk of potential malignant transformation, or are low-grade malignant tumors [5]. Some of these patients need to be treated by surgery because of symptoms like abdominal pain, distension, and jaundice, or because of the possibility of malignant transformation [6, 7]. DPPHR was initially designed for chronic pancreatitis. Although many surgeons believe that DPPHR results in improvements in intermediate and long-term outcomes which include the length of hospital stay, quality of life, postoperative rehabilitation, and preservation of exocrine function compared to PD and pylorus-preserving pancreaticoduodenectomy (PPPD) [1, 2]. Although a multi-center, randomized, controlled, double-blind ChroPac trial published in 2017 showed DPPHR to result in no difference in quality of life compared with partial pancreatoduodenectomy for chronic pancreatitis [8], DPPHR has recently been used to treat benign or low-grade malignant tumors in patients who are completely different to those with chronic pancreatitis. These patients are predominantly young females with normal pancreatic functions. A significant proportion of these patients wish to undergo minimally invasive treatment, not only because of small incisions, but also because of organ-preservation. When compared with pancreaticoduodenectomy (PD), the standard operation for pancreatic head tumors, DPPHRt maintained the integrity of the duodenum and biliary system, with non-inferiority in the short- and long-term outcomes for benign or low-grade malignant tumors [9–11]. The rapid advancements in minimally invasive technology in the past two decades have led to the increasing use of laparoscopic pancreatic surgery. Laparoscopic PD and distal pancreatectomy (DP) are now technically feasible [8], although the long-term oncological outcomes remain unclear [12, 13]. Peng et al. [14] in 2012 and Mouet [15] in 2016 reported the minimally invasive DPPHR. Cao et al. [16] in 2018 reported laparoscopic DPPHRt as a novel minimally invasive surgery for benign or low-grade malignant tumors of the pancreatic head. A systematic review showed DPPHR significantly preserved the levels of exocrine and endocrine pancreatic functions, with no significant differences in the rates of pancreatic fistula, delayed gastric emptying, and hospital mortality when compared to PD, the standard treatment for tumors of the pancreatic head [17, 18]. DPPHR, by preserving the integrity of the duodenum and biliary system with conservation of the peripancreatic tissues, should better maintain the exocrine and endocrine pancreatic functions in the short and long terms. In addition, the operation avoids the complications following a biliary anastomosis.



Some of the contexts were reused with permission from our previous papers [16].


  1. 1.
    Beger HG, Büchler M, Bittner RR, et al. Duodenum-preserving resection of the head of the pancreas in severe chronic pancreatitis. Early and late results. Ann Surg. 1989;209(3):273–8.CrossRefGoogle Scholar
  2. 2.
    Diener MK, Rahbari NN, Fischer L, et al. Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis. Ann Surg. 2008;247(6):950–61.CrossRefGoogle Scholar
  3. 3.
    Takada T, Yasuda H, Uchiyama K, et al. Duodenum-preserving pancreatoduodenostomy. A new technique for complete excision of the head of the pancreas with preservation of biliary and alimentary integrity. Hepatogastroenterology. 1993;40(4):356–9.PubMedGoogle Scholar
  4. 4.
    Takada T, Yasuda H, Uchiyama K, Hasegawa H. Complete duodenum-preserving resection of the head of the pancreas with preservation of the biliary tract. J Hepatobiliary Pancreat. 1995;2:32–7.CrossRefGoogle Scholar
  5. 5.
    Basar O, Brugge WR. My treatment approach: pancreatic cysts. Mayo Clin Proc. 2017;92(10):1519–31.CrossRefGoogle Scholar
  6. 6.
    Lawrence SA, Attiyeh MA, Seier K, et al. Should patients with cystic lesions of the pancreas undergo long-term radiographic surveillance?: Results of 3024 patients evaluated at a single institution. Ann Surg. 2017;266(3):536–44.CrossRefGoogle Scholar
  7. 7.
    Hackert T, Michalski CW, Büchler MW. Mucinous cystic neoplasms of the pancreas: a surgical disease. JAMA Surg. 2017;152(1):26.CrossRefGoogle Scholar
  8. 8.
    Diener MK, Hüttner FJ, Kieser M, et al. Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis: the multicentre, randomised, controlled, double-blind ChroPac trial. Lancet. 2017;390(10099):1027–37.CrossRefGoogle Scholar
  9. 9.
    Beger HG, Schwarz M, Poch B. Duodenum-preserving total pancreatic head resection for benign cystic neoplastic lesions. J Gastrointest Surg. 2012;16(11):2160–6.CrossRefGoogle Scholar
  10. 10.
    Beger HG, Siech M, Poch B. Duodenum-preserving total pancreatic head resection: an organ-sparing operation technique for cystic neoplasms and non-invasive malignant tumors. Chirurg. 2013;84:412–20.CrossRefGoogle Scholar
  11. 11.
    Yuan C-H, Tao M, Jia Y-M, et al. Duodenum-preserving resection and Roux-en-Y pancreatic jejunostomy in benign pancreatic head tumors. World J Gastroenterol. 2014;20(44):16786–92.CrossRefGoogle Scholar
  12. 12.
    Kutlu Onur C, Lee Jeffrey E, Katz Matthew H, et al. Open pancreaticoduodenectomy case volume predicts outcome of laparoscopic approach: a population-based analysis. Ann Surg. 2018;267(3):552–60.CrossRefGoogle Scholar
  13. 13.
    De Rooij T, Lu MZ, Steen MW, et al. Minimally invasive versus open pancreatoduodenectomy: systematic review and meta-analysis of comparative cohort and registry studies. Ann Surg. 2016;264(2):257–67.CrossRefGoogle Scholar
  14. 14.
    Peng C-H, Shen B-Y, Deng X-X, et al. Early experience for the robotic duodenum-preserving pancreatic head resection. World J Surg. 2012;36(5):1136–41.CrossRefGoogle Scholar
  15. 15.
    Zhou JY, Zhou YC, Mou YP, et al. Laparoscopic duodenum-preserving pancreatic head resection: a case report. Medicine (Baltimore). 2016;95(32):e4442.CrossRefGoogle Scholar
  16. 16.
    Cao J, Li G-L, Wei J-X, et al. Laparoscopic duodenum-preserving total pancreatic head resection: a novel surgical approach for benign or low-grade malignant tumors. Surg Endosc. 2019;33:633–8.CrossRefGoogle Scholar
  17. 17.
    Beger HG, Nakao A, Mayer B, et al. Duodenum-preserving total and partial pancreatic head resection for benign tumors--systematic review and meta-analysis. Pancreatology. 2015;15(2):167–78.CrossRefGoogle Scholar
  18. 18.
    Beger HG, Mayer B, Rau BM. Parenchyma-sparing, limited pancreatic head resection for benign tumors and low-risk periampullary cancer--a systematic review. J Gastrointest Surg. 2016;20(1):206–17.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Jun Cao
    • 1
  1. 1.Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhouChina

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