Duodenum-preserving pancreatic head resection A local parenchyma-sparing treatment of benign and premalignant tumors of the pancreatic head

摘要

Background In contrast to the Kausch-Whipple procedure (pancreatoduodenectomy) duodenum-preserving pancreatic head resection (DPPHR) is associated with tissue sparing and maintenance of the pancreatic metabolic functions. Aim According to the results of controlled clinical trials the DPPHR procedure for benign pancreatic neoplasms is associated with low surgery-related complications and maintenance of glucose metabolism and exocrine pancreatic functions. This overview summarizes the clinical results of the use of DPPHR for chronic pancreatitis and benign tumors of the pancreatic head and the status of the clinical evidence of the results. Material and methods The literature review included the results of all prospective, prospective-controlled and randomized clinical trials and meta-analyses, which analyzed and compared pancreatoduodenectomy and DPPHR for chronic pancreatitis and benign neoplasms of the pancreas. Results Compared to pancreatoduodenectomy, DPPHR exhibits significantly shorter times for surgery, shorter intensive care unit and hospital stays, lower intraoperative blood loss, lower frequency of disorders of gastric emptying and preservation of pancreatic functions. Chronic pancreatitis pancreatic fistula rates, hospital mortality and quality of life were equally low after both operations. The use of DPPHR for benign, premalignant neoplasms in adults and children and for periampullary low-risk malignancies has the advantage of a long-lasting preservation of endocrine and exocrine pancreatic functions and gastrointestinal motility. Conclusion The use of DPPHR for benign, premalignant, cystic and neuroendocrine neoplasms of the pancreatic head is associated with major advantages in the early postoperative course and preservation of gastrointestinal and pancreatic functions.