Duodenum-preserving total and partial pancreatic head resection for benign tumors--systematic review and meta-analysis.
BACKGROUND
Potential benefits of local extirpation of benign pancreatic head tumors are tissue conservation of pancreas, stomach, duodenum and common bile duct (CBD) and maintenance of pancreatic functions.


METHODS
Medline/PubMed, Embase and Cochrane Library databases were searched to identify studies applying duodenum-preserving total or partial pancreatic-head resection (DPPHRt/p) and reporting short- and long-term outcomes. Twenty-four studies, including 416 patients who underwent DPPHRt/p, were identified for systematic analysis. The meta-analysis was based on 10 prospective controlled and 4 retrospective controlled cohort studies, comparing 293 DPPHRt/p resections with 372 pancreato-duodenectomies (PD).
Of 416 patients, 75.7% underwent total and 24.3% partial head resection, while 47.1% included segmentectomy of duodenum and CBD. The most common pathology was cystic neoplasm (65.8%) and endocrine tumors (13.4%). The frequencies of severe postoperative complications of 8.8%, pancreatic fistula of 19.2%, re-operation of 1.7% and hospital mortality of 0.48%, indicate a low level of early post-operative complications.


METHODS
DPPHRt/p significantly preserved the level of exocrine (IV = -0.67, 95% CI -0.98 to -0.35, p = 0.0001) and endocrine (IV = 18.20, fixed, 95% CI -0.92 to 25.48, p = 0.0001) pancreatic functions compared to PD when the pre- and postoperative functional status in both groups are analyzed. There were no significant differences between DPPHRt/p and PD in frequency of pancreatic fistula, delayed gastric emptying or hospital mortality.


CONCLUSIONS
DPPHRt/p for benign neoplasms and neuro-endocrine tumors of the pancreatic head is associated with a low level of early-postoperative complications and a better conservation of exocrine and endocrine functions.
Department of General and Visceral Surgery, University of Ulm, Germany; Center of Oncologic, Endocrine and Minimal Invasive Surgery, Donauklinikum Neu-UIm, Germany. Electronic address: hans@beger-ulm.de.
Hans G
HG
Beger
Nagoya Central Hospital, Nagoya University, Japan.
Akimasa
A
Nakao
Department of Epidemiology and Medical Biometry, University of Ulm, Germany.
Benjamin
B
Mayer
Center of Oncologic, Endocrine and Minimal Invasive Surgery, Donauklinikum Neu-UIm, Germany.
Bertram
B
Poch
D003135:Common Bile Duct / Q000601:surgery; D004386:Duodenum / Q000601:surgery*; D006801:Humans; D010179:Pancreas / Q000601:surgery*; D010186:Pancreatic Function Tests; D010190:Pancreatic Neoplasms / Q000601:surgery*
Benign pancreatic head tumors; Cystic neoplasms; Duodenum-preserving head resection; Endocrine tumors; Limited surgery; Pancreatic functions