title: Pancreas-preserving duodenectomy is a safe alternative to high-risk pancreatoduodenectomy for premalignant duodenal lesions.
abstract: BACKGROUND
  Pancreas-preserving duodenectomy (PPD) can be considered a technical alternative to pancreaticoduodenectomy for the treatment of premalignant/low-grade malignant lesions of the duodenum. However, no many data are available comparing surgical results and costs of these two procedures.
  
  
  METHODS
  Prospectively collected data from the Karolinska University Hospital's electronic database was analyzed retrospectively for patients who underwent PD and PPD between January 2006 and December 2011. The demographics, length of stay (LOS), postoperative morbidity and mortality, and hospital costs were analyzed.
  
  
  RESULTS
  Twenty patients operated with PPD and 369 with PD were identified. Of the PDs, 81 were classified as HR-PDs, based on the intraoperative assessment of the gland. PPD patients were younger than those with HR-PD (50 vs 62 years; p = 0.0003), and with slight prevalence of overweight, BMI ≥25 (60 vs 45.7 %; p = 0.2). No differences were found in overall morbidity (55 vs 68 %; p = 0.3), in severe postoperative complications-Dindo-Clavien grade ≥3b (20 vs 30 %; p = 0.3), in delayed gastric emptying (10 vs 12 %, ns), and postpancreatectomy hemorrhage (10 vs 7.4 %, ns) between PPD and HR-PDs. However, the incidence of POPF was marginally lower in the PPD group (15 vs 37 %; p = 0.06) and was treated conservatively, while ten patients in the HR-PD group were reoperated and with POPF-associated mortality of 40 %. Also, shorter ICU stay (5 vs 12.%, ns), lower reoperation rate (10 vs 21 %, ns), lower mortality (0 vs 6.2 %), and shorter LOS (16.9 vs 24.6 days) were observed with PPD compared to HR-PD, but the numbers did not reach statistical significance. PPD was performed with shorter operative time (319 vs 418 min; p < 0.0001) and less intra-operative blood loss than HR-PD (521 vs 1027 ml; p = 0.003). The hospital costs for PPD were significantly lower than for HR-PD (29,170 vs 53,080 Euro, p = 0.03) CONCLUSIONS: PPD for resection of premalignant and low-grade malignant duodenal lesions in this small series shows to be an equivalent alternative to HR-PD, as it can be performed with shorter operative time, less intraoperative blood loss, and comparable, even slightly better, postoperative outcome and with lower costs.
authors.affiliation: Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Elena
authors.initials: E
authors.lastname: Rangelova
authors.forename: John
authors.initials: J
authors.lastname: Blomberg
authors.forename: Christoph
authors.initials: C
authors.lastname: Ansorge
authors.forename: Lars
authors.initials: L
authors.lastname: Lundell
authors.forename: Ralf
authors.initials: R
authors.lastname: Segersvärd
authors.forename: Marco
authors.initials: M
authors.lastname: Del Chiaro
mesh_terms: D000328:Adult; D000368:Aged; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000379:methods*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome