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Duodenum-preserving total pancreatic head resection for cystic neoplastic lesions in the head of the pancreas

  • Original Article
  • Published:
Journal of Hepato-Biliary-Pancreatic Surgery

Abstract

Background/Purpose

Cystic neoplastic lesions of the pancreas are now found with increasing frequency. Duodenumpreserving pancreatic head resection with segmental resection of the duodenum has been introduced for the surgical treatment of inflammatory and neoplastic lesions. We report the following data from 15 patients treated surgically for cystic neoplastic lesions of the pancreas head.

Methods

Duodenum-preserving total pancreatic head resection (DPPHRt) with segmental resection of the duodenum (SD) was performed in eight patients, five with intraductal papillary mucinous neoplasm (IPMN), two with mucinous cystic neoplasm (MCN), and one with cystic endocrine neoplasm (EN). In four patients, a subtotal pancreatic head resection was performed, but recurrence of the IPMN lesion was observed in two patients. Ten patients suffered cystadenoma, three patients had a borderline lesion, and two patients had an in-situ carcinoma.

Results

Eight patients had a DPPHRt with SD resection, two patients had a resection of the uncinate process including segmental resection of the inferior duodenal segment, and one patient had a duodenum-and spleen-preserving total pancreatectomy. In four patients a DPPHR with subtotal pancreatic head resection was carried out. Postoperative local complications occurred in eight patients: there was a recurrence of the IPMN lesion in the remnant pancreatic head in two patients; and there was intraabdominal bleeding in one patient, pancreatic fistula in one patient, and delay of gastric emptying in four patients. Seven patients showed signs of acute pancreatitis. Hospital mortality was 0%, and postoperative length of hospital stay was 10. 4 days (range, 8–18 days).

Conclusions

Duodenum-preserving total pancreatic head resection for IPMN, MCN, serous cystadenoma (SCA), and cystic EN lesions is a safe and beneficial surgical procedure. Segmental resection of the duodenum was applied for an oncologically complete resection. In regard to long-term outcome, the procedure is, additionally, a pancreatic cancer preventive strategy.

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References

  1. Kimura W, Nagai H, Kuroda A, Muto T, Esaki Y. Analysis of small cystic lesions of the pancreas. Int J Pancreatol 1995;18:197–206.

    PubMed  CAS  Google Scholar 

  2. Ohashi K, Murakami Y, Takekoshi T, Ohta H, Ohashi L. Four cases of mucin producing cancer of the pancreas on specific findings of the papilla of Vater. Prog Dig Endosc 1982;20:348–351.

    Google Scholar 

  3. Compagno J, Oertel JE. Mucinous cystic neoplasms of the pancreas with overt and latent malignancy. Am J Clin Pathol 1978;69:573–580.

    PubMed  CAS  Google Scholar 

  4. Longnecker DS, Adler G, Hruban RH, Kloppel G. Intraductal papillary-mucinous neoplasms of the pancreas. In: Hamilton SR, Aaltonen LA, editors. World Health Organisation Classification of Tumors. Pathology and genetics of tumors of the digestive system. Lyon: IARC; 2000. p. 237–241.

    Google Scholar 

  5. Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006;6:17–32.

    Article  PubMed  Google Scholar 

  6. Beger HG, Witte C, Krautzberger W, Bittner R. Erfahrung mit einer das Duodenum erhaltenden Pankreaskopfresektion bei chronischer Pankreatitis. Chirurg 1980;51:303–307.

    PubMed  CAS  Google Scholar 

  7. Beger HG, Schlosser W, Friess HM, Büchler MW. Duodenumpreserving head resection in chronic pancreatitis changes the natural course of the disease. A single-center experience. Ann Surg 1999;230;512–523.

    Article  PubMed  CAS  Google Scholar 

  8. Siech M, Thuenmayer SU, Henne-Bruns D, Beger HG. Die Behandlung zystischer Tumoren des Pankreas, radikal oder organsparend? Chirurg 2004;75:615–621.

    Article  PubMed  CAS  Google Scholar 

  9. Büchler M, Friess H, Müller MW, Wheatley AM, Beger HG. Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis. Am J Surg 1995;169:65–70.

    Article  PubMed  Google Scholar 

  10. Klempa I, Spatny M, Menzel J, et al. Pankreasfunktion und Lebensqualität nach Pankreaskopfresektion bei der chronischen Pankreatitis. Chirurg 1995;66:350–359.

    PubMed  CAS  Google Scholar 

  11. Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Broelsch CE. Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis. A prospective randomized trial. Ann Surg 1995;221:350–358.

    Article  PubMed  CAS  Google Scholar 

  12. Izbicki JR, Bloechle C, Broering DC, Knoefel WT, Kuechler T, Broelsch CE. Extended drainage versus resection in surgery for chronic pancreatitis. A prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatoduodenectomy. Ann Surg 1998;228:771–779.

    Article  PubMed  CAS  Google Scholar 

  13. Witzigmann H, Max D, Uhlmann D, Geissler F, Schwarz R, Ludwig S, et al. Outcome after duodenum-preserving pancreatic head resection is improved compared with classic Whipple procedure in the treatment of chronic pancreatitis. Surgery 2003;134:53–62.

    Article  PubMed  Google Scholar 

  14. Ito K. Duodenum preservation in pancreatic head resection to maintain pancreatic exocrine function (determined by pancreatic function diagnostant test and cholecystokinin secretion). J Hepatobiliary Pancreat Surg 2005;12:123–128.

    Article  PubMed  Google Scholar 

  15. Eddes EH, Masclee AM, Gooszen HG, Frolich M, Lamers CB. Effect of duodenum-preserving resection of the head of the pancreas on endocrine and exocrine pancreatic function in patients with chronic pancreatitis. Am J Surg 1997;174:387–392.

    Article  PubMed  CAS  Google Scholar 

  16. Eddes EH, Masclee AM, Gielkens AJ, Verkijk M, Vecht J, Biemond I, Lamers C. Cholecystokinin secretion in patients with chronic pancreatitis and after different types of pancreatic surgery. Pancreas 1999;19:119–125.

    Article  PubMed  CAS  Google Scholar 

  17. Takada T, Yasuda K, Uchiyama K, Hasegawa H. Duodenumpreserving pancreatoduodenostomy. A new technique for complete excision of the head of the pancreas with preservation of biliary and alimentary integrity. Hepatogastroenterology 1993;40:356–359.

    PubMed  CAS  Google Scholar 

  18. Imaizumi T, Hanyu F, Suzuki M, Nakasako T, Harada N, Hattori T. Clinical experience with duodenum-preserving total resection of the head of the pancreas with pancreaticocholedochoduodenostomy. J Hepatobiliary Pancreat Surg 1995;2:38–44.

    Article  Google Scholar 

  19. Schwarz A, Beger HG. Modifikation der duodenumerhaltenden Pankreaskopfresektion mit Segment-Resektion des Duodenum-Erfahrung mit 4 Patienten (Vortrag). Ulm: Jahrestagung der Mittelrheinischen Chirurgen; 1996.

    Google Scholar 

  20. Nagakawa T, Ohta T, Kayahara M, Ueno K. Total resection of the head of the pancreas preserving the duodenum, bile duct and papilla with end-to-end anstomosis of the pancreatic duct. Am J Surg 1997;173:210–212.

    Article  PubMed  CAS  Google Scholar 

  21. Nakao A. Pancreatic head resection with segmental duodenectomy and preservation of the gastroduodenal artery. Hepatogastroenterology 1998;45:533–535.

    PubMed  CAS  Google Scholar 

  22. Pedrazzoli S, Sperti C, Pasquali C. Pancreatic head resection for noninflammataory benign lesions of the head of the pancreas. Pancreas 2001;23:309–315.

    Article  PubMed  CAS  Google Scholar 

  23. Ahn YJ, Kim SW, Park YC, Jang JY, Yoon YS, Park YH. Duodenal-preserving resection of the head of the pancreas and pancreatic head resection with second-portion duodenectomy for benign lesions, low-grade malignancies and early carcinoma involving the periampullary region. Arch Surg 2003;138:162–168.

    Article  PubMed  Google Scholar 

  24. Murakami Y, Uemura K, Yokoyama Y, Sasaki M, Morifuji M, Hayashidani Y, et al. Pancreatic head resection with segmental duodenectomy for intraductal papillary mucinous tumors of the pancreas. J Gastrointest Surg 2004;8:713–718.

    Article  PubMed  Google Scholar 

  25. Schmidt-Rohlfing B, Siech M, Mattfeldt T, Schoenberg MH, Beger HG. Zystische Neoplasien des Pancreas: operative Therapie und Heilungschancen. Z Gastroenterol 1998;36:939–943.

    PubMed  CAS  Google Scholar 

  26. Kimura W. IHPBA in Tokyo 2002: surgical treatment in IPMT vs MCT: a Japanese experience. J Hepatobiliary Pancreat Surg 2003;10:156–162.

    Article  PubMed  Google Scholar 

  27. Yi S, Ohta T, Miwa K, Akita K, Tanaka S. Surgical anatomy of the innervation of the major duodenal papilla in human and Suncus murinus, concerning the operative procedure of the duodenum-preserving subtotal or local resection of the pancreatic head. World J Gastroenterol 2006;12:2209–2216.

    PubMed  Google Scholar 

  28. Formentini A, Birk D, Siech M, Mattfeldt T, Fortnagel G, Beger HG. Serous cystadenocarcinoma of the pancreas; serous cystadenoma associated with ductal pancreatic adenocarcinoma. J HBP Surg 2000;2:41–48.

    Google Scholar 

  29. Fernandez-del Castillo C, Warshaw AC. Cystic tumors of the pancreas. In: Beger HG, Warshaw A, Büchler M, Carr-Locke D, Neoptolemos J, Russell C, et al., editors. The Pancreas. First ed. London: Blackwell Science; 1998. p. 1383–1394.

    Google Scholar 

  30. Ikenaga H, Katoh H, Motohara T, Okushiba S, Shimozawa E, Kanaya S, Takahashi T. Duodenum-preserving resection of the head of the pancreas-modified procedures and long-term results. Hepatogastroenterology 1995;42:706–710.

    PubMed  CAS  Google Scholar 

  31. Sarr MG, Murr M, Smyrk T, Yeo CJ, Fernandez-del Castillo C, Harwes RH, Freeny PC. Primary cystic neoplasms of the pancreas: neoplastic disorders of emerging importance — current state-of-the-art and unanswered questions. J Gastrointest Surg 2003;7:417–427.

    Article  PubMed  Google Scholar 

  32. Kimura W, Fuse A, Hirai I, Suto K. Spleen-preserving distal pancreatectomy for intraductal papillary-mucinous tumor (IPMT). Hepatogastroenterology 2004;51:86–90.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. c/o Universitätsklinikum Ulm, Steinhövelstrasse 9, D-89075, Ulm, Germany

    Hans G. Beger

  2. Department of Visceral Surgery, Donau-Klinik, Neu-Ulm, Germany

    Hans G. Beger, Frank Gansauge, Michael Schwarz & Bertram Poch

  3. Department of General-, Vascular-and Visceral Surgery, Ostalb Klinikum, Aalen, Germany

    Marko Siech

Authors
  1. Hans G. Beger
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  2. Frank Gansauge
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  3. Marko Siech
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  4. Michael Schwarz
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  5. Bertram Poch
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Beger, H.G., Gansauge, F., Siech, M. et al. Duodenum-preserving total pancreatic head resection for cystic neoplastic lesions in the head of the pancreas. J Hepatobiliary Pancreat Surg 15, 149–156 (2008). https://doi.org/10.1007/s00534-007-1227-4

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  • DOI: https://doi.org/10.1007/s00534-007-1227-4

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