Duodenum-preserving versus pylorus-preserving pancreatic head resection for benign and premalignant lesions.
OBJECTIVE
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.
Pedrazzoli
Sergio
S
Department of Medical and Surgical Sciences, IV Surgical Clinic, University of Padova, Ospedale Giustinianeo, Via Giustiniani 2, 35128 Padua, Italy. sergio.pedrazzoli@unipd.it
Canton
Silvio Alen
SA
Sperti
Cosimo
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004386:Duodenum / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D011230:Precancerous Conditions / Q000601:surgery*; D011708:Pylorus / Q000601:surgery; D016896:Treatment Outcome