title: Modified duodenum-preserving pancreas head resection for low-grade malignant lesion in the pancreatic head.
abstract: OBJECTIVE
  Our institution has utilized a duodenum-preserving pancreas head resection (DPPHR) procedure for management of low-grade malignant lesions within the head of the pancreas, but this has resulted in a higher rate of postoperative complications, including pancreatic fistula and ischemic bile duct injury. To avoid these complications we recently modified DPPHR to resect all the parenchyma around the pancreatic head and to preserve the epicholedochal plexus around the bile duct. The goal of this study was to investigate outcomes with postoperative complications and disease control following this modified procedure.
  
  
  METHODS
  Twenty-one consecutive patients underwent DPPHR between 1994 and 2011. Patients were retrospectively classified into one of two groups: the conventional DPPHR group (cDPPHR) or the modified DPPHR group (mDPPHR). Perioperative factors and postoperative complications were compared between these two groups.
  
  
  RESULTS
  The median age of the 21 patients was 61 (23-77) years, and the median follow-up period was 51 months. Intra-operational blood loss was significantly smaller and duration of hospital stay was significantly shorter in the mDPPHR group than in the cDPPHR group, respectively. The rate of pancreatic fistula was markedly lower in the mDPPHR group (2/13; 15%) than in the cDPPHR group (7/8; 88%) (P = 0.0022). For neoplastic lesions, the surgical margin was negative in all cases, and local recurrence has not occurred in either group.
  
  
  CONCLUSIONS
  For selected patients, modified DPPHR may provide clinical benefits in terms of less complications associated with shorter hospital stay.
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University, Graduate School of Medicine, N-15 W-7, Sapporo 060-8638, Japan. tsuchi-t@med.hokudai.ac.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuchikawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kato
authors.forename: Joe
authors.initials: J
authors.lastname: Matsumoto
authors.forename: Toru
authors.initials: T
authors.lastname: Nakamura
authors.forename: Yuma
authors.initials: Y
authors.lastname: Ebihara
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shichinohe
authors.forename: Masaki
authors.initials: M
authors.lastname: Miyamoto
mesh_terms: D000328:Adult; D000368:Aged; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D055815:Young Adult