Advances in clinical and minimally invasive applications of duodenum<b>-</b>preserving pancreatic head resection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Song ,  LU Xingsheng

Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu 215000, P. R. China;

Corresponding author：

LU Xingsheng, Email: luxingsheng88@sina.com

Keywords：

duodenum-preserving pancreatic head resection; benign pancreatic disease; chronic pancreatitis; benign tumor of pancreatic head; minimally invasive pancreatic surgery

DOI：

10.7507/1007-9424.202306060

Video：

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Objective To explore the advantages and disadvantages of duodenum-preserving pancreatic head resection (DPPHR) in the clinical application of pancreatic surgical diseases, and to summarize the progress of minimally invasive application of DPPHR combined with the current application of laparoscopy and robot surgery in pancreatic surgery. Method The related research literatures about DPPHR at home and abroad in recent years were searched and reviewed. Results The effect of DPPHR compared with traditional pancreaticoduodenectomy (PD) for treatment of benign pancreatic diseases was still controversial, and the postoperative remission effect, perioperative period, occurrence of long-term complications and improvement of quality of life were not very advantageous compared with PD, and the prognosis of minimally invasive surgery was poor. Conclusion DPPHR remains highly controversial for surgical intervention in benign pancreatic disease and has enormous scope for advances in minimally invasive surgical applications in pancreatic surgery, but more clinical studies are needed to verify its clinical efficacy.

Citation： LIU Song, LU Xingsheng. Advances in clinical and minimally invasive applications of duodenum-preserving pancreatic head resection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(11): 1395-1401. doi: 10.7507/1007-9424.202306060 Copy

1.	Komokata T, Nuruki K, Tada N, et al. An invaginated pancreaticogastrostomy following subtotal stomach-preserving pancreaticoduodenectomy: a prospective observational study. Asian J Surg, 2021, 44(12): 1510-1514.
2.	Kono H, Hosomura N, Amemiya H, et al. Rikkunshito increases appetite by enhancing gastrointestinal and incretin hormone levels in patients who underwent pylorus-preserving pancreaticoduodenectomy: a retrospective study. World J Gastrointest Surg, 2023, 15(5): 871-881.
3.	Beger HG, Krautzberger W, Bittner R, et al. Duodenum-sparing pancreas head resection in chronic pancreatitis-results after 10 years’ use. Langenbecks Arch Chir, 1984, 362(4): 229-236.
4.	Beger HG, Krautzberger W, Bittner R, et al. Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery, 1985, 97(4): 467-473.
5.	Beger HG, Witte C, Krautzberger W, et al. Experiences with duodenum-sparing pancreas head resection in chronic pancreatitis. Chirurg, 1980, 51(5): 303-307.
6.	苏琨, 王连敏, 马朝宇, 等. 保留十二指肠的胰头切除术与胰管切开取石胰腺管空肠吻合术在胰腺头部结石中的临床疗效. 昆明医科大学学报, 2023, 44(3): 103-112.
7.	董志毅. 保留十二指肠的胰头切除术在胰头部良性病变中的应用及对术后生活质量的影响研究. 中华普外科手术学杂志(电子版), 2017, 11(6): 528-530.
8.	Guo S, Zhou Q, Yang J, et al. Duodenum-preserving pancreatic head resection compared to pancreaticoduodenectomy: a systematic review and network meta-analysis of surgical outcomes. Front Surg, 2023, 10: 1107613.
9.	秦仁义, 彭丰. 腹腔镜胰十二指肠切除术临床研究进展及方向. 中国实用外科杂志, 2022, 42(5): 494-497.
10.	付逸博, 邱江东, 张太平. 微创胰十二指肠切除术的研究现状与展望. 腹部外科, 2021, 34(5): 331-335.
11.	Beger HG, Mayer B, Poch B. Duodenum-preserving pancreatic head resection: a local parenchyma-sparing treatment of benign and premalignant tumors of the pancreatic head. Chirurg, 2019, 90(9): 736-743.
12.	Beger HG, Mayer B, Poch B. Duodenum-preserving pancreatic head resection for benign and premalignant tumors-a systematic review and meta-analysis of surgery-associated morbidity. J Gastrointest Surg, 2023 Sep 5. doi: 10.1007/s11605-023-05789-4. Online ahead of print.
13.	Laramée P, Wonderling D, Cahen DL, et al. Trial-based cost-effectiveness analysis comparing surgical and endoscopic drainage in patients with obstructive chronic pancreatitis. BMJ Open, 2013, 3(9): e003676.
14.	Ahmed Ali U, Pahlplatz JM, Nealon WH, et al. Endoscopic or surgical intervention for painful obstructive chronic pancreatitis. Cochrane Database Syst Rev, 2012, 1: CD007884.
15.	Díte P, Ruzicka M, Zboril V, et al. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy, 2003, 35(7): 553-558.
16.	Cahen DL, Gouma DJ, Nio Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med, 2007, 356(7): 676-684.
17.	Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas, 1987, 2(6): 701-707.
18.	Takada T, Yasuda H, Uchiyama K, et al. Duodenum-preserving pancreatoduodenostomy. A new technique for complete excision of the head of the pancreas with preservation of biliary and alimentary integrity. Hepatogastroenterology, 1993, 40(4): 356-359.
19.	Gloor B, Friess H, Uhl W, et al. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig Surg, 2001, 18(1): 21-25.
20.	Hatori T, Imaizumi T, Harada N, et al. Appraisal of the Imaizumi modification of the Beger procedure: the TWMU experience. J Hepatobiliary Pancreat Sci, 2010, 17(6): 752-757.
21.	Bachmann K, Tomkoetter L, Kutup A, et al. Is the Whipple procedure harmful for long-term outcome in treatment of chronic pancreatitis? 15-years follow-up comparing the outcome after pylorus-preserving pancreatoduodenectomy and Frey procedure in chronic pancreatitis. Ann Surg, 2013, 258(5): 815-820.
22.	Beger HG, Nakao A, Mayer B, et al. Duodenum-preserving total and partial pancreatic head resection for benign tumors—systematic review and meta-analysis. Pancreatology, 2015, 15(2): 167-178.
23.	Gong DJ, Zhang JM, Mao GJ, et al. Duodenum-preserving pancreatic head resection vs. pancreatoduodenectomy for benign lesions and low-grade malignancies of the pancreatic head. Hepatogastroenterology, 2013, 60(121): 19-22.
24.	Tsuchikawa T, Hirano S, Tanaka E, et al. Modified duodenum-preserving pancreas head resection for low-grade malignant lesion in the pancreatic head. Pancreatology, 2013, 13(2): 170-174.
25.	Zhao X, Cui N, Wang X, et al. Surgical strategies in the treatment of chronic pancreatitis: an updated systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2017, 96(9): e6220.
26.	Diener MK, Hüttner FJ, Kieser M, et al. Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis: the multicentre, randomised, controlled, double-blind ChroPac trial. Lancet, 2017, 390(10099): 1027-1037.
27.	Ghorbani P, Dankha R, Brisson R, et al. Surgical outcomes and trends for chronic pancreatitis: an observational cohort study from a high-volume centre. J Clin Med, 2022, 11(8): 2105.
28.	刘续宝. 慢性胰腺炎的胰头炎性包块的外科治疗. 中国普外基础与临床杂志, 2013, 20(2): 121-123.
29.	张太平, 曹喆, 赵玉沛. 慢性胰腺炎合并胰头肿块的外科治疗策略. 中国普外基础与临床杂志, 2016, 23(6): 644-646.
30.	Beger HG, Mayer B, Poch B. Parenchyma-sparing, local pancreatic head resection for premalignant and low-malignant neoplasms—a systematic review and meta-analysis. Am J Surg, 2018, 216(6): 1182-1191.
31.	Brown EG, Yang A, Canter RJ, et al. Outcomes of pancreatico-duodenectomy: where should we focus our efforts on improving outcomes? JAMA Surg, 2014, 149(7): 694-699.
32.	Ke FY, Wu XS, Zhang Y, et al. Comparison of postoperative complications between internal and external pancreatic duct stenting during pancreaticoduodenectomy: a meta-analysis. Chin J Cancer Res, 2015, 27(4): 397-407.
33.	Diener MK, Rahbari NN, Fischer L, et al. Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis. Ann Surg, 2008, 247(6): 950-961.
34.	Fang K, Sun G, Zha M, et al. Organ-sparing pancreatectomy for benign or low-grade malignant pancreatic tumors: a single-center experience with 101 consecutive patients. Med Sci Monit, 2022, 28: e935685.
35.	Beger HG, Mayer B, Vasilescu C, et al. Long-term metabolic morbidity and steatohepatosis following standard pancreatic resections and parenchyma-sparing, local extirpations for benign tumor: a systematic review and meta-analysis. Ann Surg, 2022, 275(1): 54-66.
36.	Marengo A, Rosso C, Bugianesi E. Liver cancer: connections with obesity, fatty liver, and cirrhosis. Annu Rev Med, 2016, 67: 103-117.
37.	Castellanos-Fernandez MI, Pal SC, Arrese M, et al. Nonalcoholic fatty liver disease in Latin America and Australia. Clin Liver Dis, 2023, 27(2): 301-315.
38.	Kato H, Asano Y, Ito M, et al. Significant positive impact of duodenum-preserving pancreatic head resection on the prevention of postoperative nonalcoholic fatty liver disease and acute cholangitis. Ann Gastroenterol Surg, 2022, 6(6): 851-861.
39.	Murata Y, Mizuno S, Kato H, et al. Nonalcoholic steatohepatitis (NASH) after pancreaticoduodenectomy: association of pancreatic exocrine deficiency and infection. Clin J Gastroenterol, 2011, 4(4): 242-248.
40.	Zheng Z, Xiang G, Tan C, et al. Pancreaticoduodenectomy versus duodenum-preserving pancreatic head resection for the treatment of chronic pancreatitis. Pancreas, 2012, 41(1): 147-152.
41.	刘清泉, 曹振, 郭世称, 等. 腹腔镜保留十二指肠胰头切除术单中心临床疗效分析. 江西医药, 2021, 56(12): 2132-2135.
42.	Jiang Y, Jin JB, Zhan Q, et al. Robot-assisted duodenum-preserving pancreatic head resection with pancreaticogastrostomy for benign or premalignant pancreatic head lesions: a single-centre experience. Int J Med Robot, 2018, 14(4): e1903.
43.	Liu M, Ji S, Xu W, et al. Laparoscopic pancreaticoduodenectomy: are the best times coming? World J Surg Oncol, 2019, 17(1): 81. doi: 10.1186/s12957-019-1624-6.
44.	Zhang W, Huang Z, Zhang J, et al. Safety and efficacy of robot-assisted versus open pancreaticoduodenectomy: a meta-analysis of multiple worldwide centers. Updates Surg, 2021, 73(3): 893-907.
45.	Lu C, Xu B, Mou Y, et al. Laparoscopic duodenum-preserving pancreatic head resection with real-time indocyanine green guidance of different dosage and timing: enhanced safety with visualized biliary duct and its long-term metabolic morbidity. Langenbecks Arch Surg, 2022, 407(7): 2823-2832.

1. Komokata T, Nuruki K, Tada N, et al. An invaginated pancreaticogastrostomy following subtotal stomach-preserving pancreaticoduodenectomy: a prospective observational study. Asian J Surg, 2021, 44(12): 1510-1514.
2. Kono H, Hosomura N, Amemiya H, et al. Rikkunshito increases appetite by enhancing gastrointestinal and incretin hormone levels in patients who underwent pylorus-preserving pancreaticoduodenectomy: a retrospective study. World J Gastrointest Surg, 2023, 15(5): 871-881.
3. Beger HG, Krautzberger W, Bittner R, et al. Duodenum-sparing pancreas head resection in chronic pancreatitis-results after 10 years’ use. Langenbecks Arch Chir, 1984, 362(4): 229-236.
4. Beger HG, Krautzberger W, Bittner R, et al. Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery, 1985, 97(4): 467-473.
5. Beger HG, Witte C, Krautzberger W, et al. Experiences with duodenum-sparing pancreas head resection in chronic pancreatitis. Chirurg, 1980, 51(5): 303-307.
6. 苏琨, 王连敏, 马朝宇, 等. 保留十二指肠的胰头切除术与胰管切开取石胰腺管空肠吻合术在胰腺头部结石中的临床疗效. 昆明医科大学学报, 2023, 44(3): 103-112.
7. 董志毅. 保留十二指肠的胰头切除术在胰头部良性病变中的应用及对术后生活质量的影响研究. 中华普外科手术学杂志(电子版), 2017, 11(6): 528-530.
8. Guo S, Zhou Q, Yang J, et al. Duodenum-preserving pancreatic head resection compared to pancreaticoduodenectomy: a systematic review and network meta-analysis of surgical outcomes. Front Surg, 2023, 10: 1107613.
9. 秦仁义, 彭丰. 腹腔镜胰十二指肠切除术临床研究进展及方向. 中国实用外科杂志, 2022, 42(5): 494-497.
10. 付逸博, 邱江东, 张太平. 微创胰十二指肠切除术的研究现状与展望. 腹部外科, 2021, 34(5): 331-335.
11. Beger HG, Mayer B, Poch B. Duodenum-preserving pancreatic head resection: a local parenchyma-sparing treatment of benign and premalignant tumors of the pancreatic head. Chirurg, 2019, 90(9): 736-743.
12. Beger HG, Mayer B, Poch B. Duodenum-preserving pancreatic head resection for benign and premalignant tumors-a systematic review and meta-analysis of surgery-associated morbidity. J Gastrointest Surg, 2023 Sep 5. doi: 10.1007/s11605-023-05789-4. Online ahead of print.
13. Laramée P, Wonderling D, Cahen DL, et al. Trial-based cost-effectiveness analysis comparing surgical and endoscopic drainage in patients with obstructive chronic pancreatitis. BMJ Open, 2013, 3(9): e003676.
14. Ahmed Ali U, Pahlplatz JM, Nealon WH, et al. Endoscopic or surgical intervention for painful obstructive chronic pancreatitis. Cochrane Database Syst Rev, 2012, 1: CD007884.
15. Díte P, Ruzicka M, Zboril V, et al. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy, 2003, 35(7): 553-558.
16. Cahen DL, Gouma DJ, Nio Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med, 2007, 356(7): 676-684.
17. Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas, 1987, 2(6): 701-707.
18. Takada T, Yasuda H, Uchiyama K, et al. Duodenum-preserving pancreatoduodenostomy. A new technique for complete excision of the head of the pancreas with preservation of biliary and alimentary integrity. Hepatogastroenterology, 1993, 40(4): 356-359.
19. Gloor B, Friess H, Uhl W, et al. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig Surg, 2001, 18(1): 21-25.
20. Hatori T, Imaizumi T, Harada N, et al. Appraisal of the Imaizumi modification of the Beger procedure: the TWMU experience. J Hepatobiliary Pancreat Sci, 2010, 17(6): 752-757.
21. Bachmann K, Tomkoetter L, Kutup A, et al. Is the Whipple procedure harmful for long-term outcome in treatment of chronic pancreatitis? 15-years follow-up comparing the outcome after pylorus-preserving pancreatoduodenectomy and Frey procedure in chronic pancreatitis. Ann Surg, 2013, 258(5): 815-820.
22. Beger HG, Nakao A, Mayer B, et al. Duodenum-preserving total and partial pancreatic head resection for benign tumors—systematic review and meta-analysis. Pancreatology, 2015, 15(2): 167-178.
23. Gong DJ, Zhang JM, Mao GJ, et al. Duodenum-preserving pancreatic head resection vs. pancreatoduodenectomy for benign lesions and low-grade malignancies of the pancreatic head. Hepatogastroenterology, 2013, 60(121): 19-22.
24. Tsuchikawa T, Hirano S, Tanaka E, et al. Modified duodenum-preserving pancreas head resection for low-grade malignant lesion in the pancreatic head. Pancreatology, 2013, 13(2): 170-174.
25. Zhao X, Cui N, Wang X, et al. Surgical strategies in the treatment of chronic pancreatitis: an updated systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2017, 96(9): e6220.
26. Diener MK, Hüttner FJ, Kieser M, et al. Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis: the multicentre, randomised, controlled, double-blind ChroPac trial. Lancet, 2017, 390(10099): 1027-1037.
27. Ghorbani P, Dankha R, Brisson R, et al. Surgical outcomes and trends for chronic pancreatitis: an observational cohort study from a high-volume centre. J Clin Med, 2022, 11(8): 2105.
28. 刘续宝. 慢性胰腺炎的胰头炎性包块的外科治疗. 中国普外基础与临床杂志, 2013, 20(2): 121-123.
29. 张太平, 曹喆, 赵玉沛. 慢性胰腺炎合并胰头肿块的外科治疗策略. 中国普外基础与临床杂志, 2016, 23(6): 644-646.
30. Beger HG, Mayer B, Poch B. Parenchyma-sparing, local pancreatic head resection for premalignant and low-malignant neoplasms—a systematic review and meta-analysis. Am J Surg, 2018, 216(6): 1182-1191.
31. Brown EG, Yang A, Canter RJ, et al. Outcomes of pancreatico-duodenectomy: where should we focus our efforts on improving outcomes? JAMA Surg, 2014, 149(7): 694-699.
32. Ke FY, Wu XS, Zhang Y, et al. Comparison of postoperative complications between internal and external pancreatic duct stenting during pancreaticoduodenectomy: a meta-analysis. Chin J Cancer Res, 2015, 27(4): 397-407.
33. Diener MK, Rahbari NN, Fischer L, et al. Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis. Ann Surg, 2008, 247(6): 950-961.
34. Fang K, Sun G, Zha M, et al. Organ-sparing pancreatectomy for benign or low-grade malignant pancreatic tumors: a single-center experience with 101 consecutive patients. Med Sci Monit, 2022, 28: e935685.
35. Beger HG, Mayer B, Vasilescu C, et al. Long-term metabolic morbidity and steatohepatosis following standard pancreatic resections and parenchyma-sparing, local extirpations for benign tumor: a systematic review and meta-analysis. Ann Surg, 2022, 275(1): 54-66.
36. Marengo A, Rosso C, Bugianesi E. Liver cancer: connections with obesity, fatty liver, and cirrhosis. Annu Rev Med, 2016, 67: 103-117.
37. Castellanos-Fernandez MI, Pal SC, Arrese M, et al. Nonalcoholic fatty liver disease in Latin America and Australia. Clin Liver Dis, 2023, 27(2): 301-315.
38. Kato H, Asano Y, Ito M, et al. Significant positive impact of duodenum-preserving pancreatic head resection on the prevention of postoperative nonalcoholic fatty liver disease and acute cholangitis. Ann Gastroenterol Surg, 2022, 6(6): 851-861.
39. Murata Y, Mizuno S, Kato H, et al. Nonalcoholic steatohepatitis (NASH) after pancreaticoduodenectomy: association of pancreatic exocrine deficiency and infection. Clin J Gastroenterol, 2011, 4(4): 242-248.
40. Zheng Z, Xiang G, Tan C, et al. Pancreaticoduodenectomy versus duodenum-preserving pancreatic head resection for the treatment of chronic pancreatitis. Pancreas, 2012, 41(1): 147-152.
41. 刘清泉, 曹振, 郭世称, 等. 腹腔镜保留十二指肠胰头切除术单中心临床疗效分析. 江西医药, 2021, 56(12): 2132-2135.
42. Jiang Y, Jin JB, Zhan Q, et al. Robot-assisted duodenum-preserving pancreatic head resection with pancreaticogastrostomy for benign or premalignant pancreatic head lesions: a single-centre experience. Int J Med Robot, 2018, 14(4): e1903.
43. Liu M, Ji S, Xu W, et al. Laparoscopic pancreaticoduodenectomy: are the best times coming? World J Surg Oncol, 2019, 17(1): 81. doi: 10.1186/s12957-019-1624-6.
44. Zhang W, Huang Z, Zhang J, et al. Safety and efficacy of robot-assisted versus open pancreaticoduodenectomy: a meta-analysis of multiple worldwide centers. Updates Surg, 2021, 73(3): 893-907.
45. Lu C, Xu B, Mou Y, et al. Laparoscopic duodenum-preserving pancreatic head resection with real-time indocyanine green guidance of different dosage and timing: enhanced safety with visualized biliary duct and its long-term metabolic morbidity. Langenbecks Arch Surg, 2022, 407(7): 2823-2832.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Advances in clinical and minimally invasive applications of duodenum-preserving pancreatic head resection

Abstract Full text Figures/Tables Video References Cited by

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