Clinical effect of minimally invasive duodenum preserving pancreatic head resection for benign and pre-malignant lesions of pancreatic head.
10.3760/cma.j.cn112139-20211104-00516
- VernacularTitle:微创保留十二指肠的胰头切除术治疗胰头良性和交界性肿瘤的临床效果分析
- Author:
Chao LU
1
;
Wei Wei JIN
1
;
Yi Ping MOU
1
;
Yu Cheng ZHOU
1
;
Yuan Yu WANG
1
;
Tao XIA
1
;
Qi Cong ZHU
1
;
Bi Wu XU
2
;
Yu Feng REN
3
;
Si Jia MENG
2
;
Yu Hui HE
3
;
Qi Tao JIANG
2
Author Information
1. Department of General Surgery,Division of Gastrointestinal and Pancreatic Surgery,Zhejiang Provincial People's Hospital(People's Hospital of Hangzhou Medical College),Key Laboratory of Gastroenterology of Zhejiang Province,Hangzhou 310014,China.
2. Bengbu Medical College,Bengbu 233030,China.
3. Zhejiang University of Traditional Chinese Medicine,Hangzhou 310053,China.
- Publication Type:Journal Article
- MeSH:
Adolescent;
Adult;
Aged;
Child;
Duodenum/surgery*;
Female;
Humans;
Male;
Middle Aged;
Pancreas/surgery*;
Pancreatectomy;
Pancreatic Neoplasms/surgery*;
Pancreaticoduodenectomy;
Postoperative Complications;
Retrospective Studies;
Young Adult
- From:
Chinese Journal of Surgery
2022;60(1):39-45
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To examine the clinical effect of minimally invasive duodenum preserving pancreatic head resection(DPPHR) for benign and pre-malignant lesions of pancreatic head. Methods: The clinical data of patients with diagnosis of benign or pre-malignant pancreatic head tumor were retrospectively collected and analyzed,all of them underwent laparoscopic or robotic DPPHR between October 2015 and September 2021 at Division of Gastrointestinal and Pancreatic surgery,Zhejiang Provincial People's Hospital. Thirty-three patients were enrolled with 10 males and 23 females. The age(M(IQR)) was 54(32) years old(range: 11 to 77 years old) and the body mass index was 21.9(2.9)kg/m2(range: 18.1 to 30.1 kg/m2). The presenting symptoms included abdominal pain(n=12), Whipple triad(n=2), and asymptomatic(n=19). There were 7 patients with hypertension and 1 patient with diabetes mellitus. There were 19 patients who were diagnosed as American Society of Anesthesiologists class Ⅰ and 14 patients who were diagnosed as class Ⅱ. The student t test,U test, χ2 test or Fisher exact test was used to compare continuous data or categorized data,respectively. All the perioperative data and metabolic morbidity were analyzed and experiences on minimally invasive DPPHR were concluded. Results: Fourteen patients underwent laparoscopic DPPHR,while the rest of 19 patients received robotic DPPHR. Indocyanine green fluorescence imaging was used in 19 patients to guide operation. Five patients were performed pancreatico-gastrostomy and the rest 28 patients underwent pancreaticojejunostomy. Pathological outcomes confirmed 9 solid pseudo-papillary neoplasms, 9 intraductal papillary mucinous neoplasms, 7 serous cystic neoplasms, 6 pancreatic neuroendocrine tumors, 1 mucous cystic neoplasm, 1 chronic pancreatitis. The operative time was (309.4±50.3) minutes(range:180 to 420 minutes),and the blood loss was (97.9±48.3)ml(range:20 to 200 ml). Eighteen patients suffered from postoperative complications,including 3 patients experienced severe complications(Clavien-Dindo Grade ≥Ⅲ). Pancreatic fistula occurred in 16 patients,including 8 patients with biochemical leak,7 patients with grade B pancreatic fistula and 1 patient with grade C pancreatic fistula. No one suffered from the duodenal necrosis and none perioperative death was occurred. The length of hospital stay was 14(7) days (range:6 to 87 days). The follow-up was 22.6(24.5)months(range:2 to 74 months). None suffered from recurrence or metastasis. During the follow-up,all the patients were free of refractory cholangitis. Moreover,in the term of endocrine dysfunction,no postoperative new onset of diabetes mellitus were observed in the long-term follow-up. However,in the view of exocrine insufficiency,pancreatic exocrine insufficiency and non-alcoholic fatty liver disease (NAFLD) was complicated in 2 and 1 patient,respectively,with the supplement of pancreatic enzyme,steatorrhea and weight loss relieved,but NAFLD was awaited to be seen. Conclusions: Minimally invasive DPPHR is feasible and safe for benign or pre-malignant lesions of pancreatic head. Moreover,it is oncological equivalent to pancreaticoduodenectomy with preservation of metabolic function without refractory cholangitis.
