Clinical efficacy of organ-preserving pancreatectomy for benign or low-grade malignant potential lesion

Abstract

The clinical usefulness of organ-preserving pancreatectomy is not well established due to technical difficulty and ambiguity of functional merit. The purpose of this study is to evaluate the clinical efficacy of organ-preserving pancreatectomy such as duodenum-preserving resection of the head of the pancreas (DPRHP), pancreatic head resection with segmental duodenectomy (PHRSD), central pancreatectomy (CP) and spleen-preserving distal pancreatectomy (SPDP). Between 1995 and 2007, the DPRHP were performed in 14 patients, the PHRSD in 16 patients, the CP in 13 patients, and the SPDP in 45 patients for preoperatively diagnosed benign lesions or tumors with low-grade malignant potential. The clinical outcomes including surgical details, postoperative complications and long-term functional outcomes were compared between organ-preserving pancreatectomy and conventional pancreatectomy group. Major postoperative complications constituted the following: bile duct stricture (7.1% [1/14]) in DPRHP, delayed gastric emptying (31.2% [5/16]) in PHRSD, pancreatic fistula (21.4% [3/14]) in CP. There were no significant differences in postoperative complications and long-term functional outcomes between two groups. Organ-preserving pancreatectomy is associated with tolerable postoperative complications, and good long-term outcome comparing to conventional pancreatectomy. Organ-preserving pancreatectomy could be alternative treatment for benign or low-grade malignant potential lesion of the pancreas or ampullary/parapapillary duodenum.

Keywords: Low-Grade Malignant; Organ-Preserving; Pancreatectomy.

Fig. 1

Schematic diagram of the duodenal-preserving resection of the head of the pancreas (adopted from ref., Arch Surg 2003;138:162-8). (A) Operative procedure of DPRHP. ASPDA indicates anterior superior pancreaticoduodenal artery. (B) View after the total resection of the head of the pancreas, pancreatogastrostomy, T tube insertion, and pancreatic diversion were performed. AIPDA, anterior inferior pancreaticoduodenal artery; CBD, common bile duct; GDA, gastroduodenal artery; GEA, gastroepiploic artery; SMV, superior mesenteric vein.

Fig. 2

Schematic diagram of the pancreas head resection with segmental duodenectomy (adopted from ref., Arch Surg 2003;138:162-8). (A) Operative procedure of PHRSD. (B) View after the resection, a pancreatogastrostomy, an end-to-side choledochoduodenostomy with a T-tube stent, and an end-to-end duodenoduodenostomy were performed.