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Short-Term Outcomes of Laparoscopic Duodenum-Preserving Total Pancreatic Head Resection Compared with Laparoscopic Pancreaticoduodenectomy for the Management of Pancreatic-Head Benign or Low-Grade Malignant Lesions

Xuemin Chen, Weibo Chen, Yue Zhang, Yong An, Xiaoying Zhang

Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)

Med Sci Monit 2020; 26:e927248

DOI: 10.12659/MSM.927248

Available online: 2020-09-09

Published: 2020-09-16

BACKGROUND: Several studies have shown that laparoscopic duodenum-preserving total pancreatic head resection (LDPPHRt) is safe, effective, and feasible for the management of pancreatic-head benign or low-grade malignant lesions. However, there are no studies comparing the short-term outcomes between LDPPHRt and laparoscopic pancreaticoduodenectomy (LPD). The present study aimed to evaluate the differences in the intraoperative data, postoperative data, short-term complications, and 90-day mortality rates between LDPPHRt and LPD in the management of pancreatic-head benign or low-grade malignant tumors.
MATERIAL AND METHODS: Between January 2016 and December 2019, 15 LDPPHRt and 39 LPD procedures were performed. The preoperative, intraoperative, and postoperative data were retrospectively analyzed and compared.
RESULTS: All of the patients received laparoscopic procedures successfully and without conversion. There were no differences in the patients’ age, body mass index, American Society of Anaesthesiologists score, preoperative examination results, preoperative initial symptoms, comorbidities, intraoperative blood loss, postoperative stay, short-term complications, 30-day readmission rates, or 90-day mortality rates. More female patients underwent LDPPHRt than LPD (73.3% vs. 38.5%; P=0.033), and no patients in the LDPPHRt group had previously undergone abdominal surgery (0% vs. 20.1%; P=0.049). The operative time was shorter in the LDPPHRt group than in the LPD group (295±42 vs. 357±87 min; P=0.011). The lesion diameter did not differ significantly between the 2 groups (2.93±1.18 vs. 2.53±1.12 cm; P=0.252). The lesion resection margins were all histopathologically negative. The distribution of pathological diagnosis was comparable in both groups. The LDPPHRt group had 4 cases of intraductal papillary mucinous neoplasm (IPMN) (26.7%), 1 case of solid pseudopapillary tumor (SPN) (6.7%), 2 cases of pancreatic neuroendocrine neoplasm (PNET) (13.3%), 2 cases of serous cystic adenoma (SCA) (13.3%), 4 cases of mucinous cystic neoplasm (MCN) (26.7%), and 2 cases of chronic pancreatitis (13.3%). The LPD group had 21 cases of IPMN (53.8%), 2 cases of SPN (5.1%), 7 cases of PNET (17.9%), 3 cases of SCA (7.7%), 2 cases of MCN (5.1%), and 4 cases of chronic pancreatitis (10.3%).
CONCLUSIONS: LDPPHRt is a time-saving procedure with short-term outcomes comparable to those of LPD for the management of benign or low-grade malignancies of the pancreatic head.

Keywords: Common Bile Duct, Laparoscopy, Total Pancreatic Head Resection, Duodenum Preservation