Duodenum-preserving pancreatic head resection in 1063 patients for benign, premalignant cystic, and neuroendocrine neoplasms - Short-term surgical outcomes and risk of recurrence - Results of a systematic review

Abstract

Background: To prevent malignant transformation to advanced cancer of premalignant cystic neoplasms and neuroendocrine tumors of the pancreatic head, the objective arises whether oncologic multiorgan PD or parenchyma-sparing, duodenum-preserving resection (DPPHR) should be performed.

Methods: Pubmed, Medline, Embase and Cochrane libraries were searched for studies reporting postoperative results and late outcome after DPPHR. Data from 49 cohort studies including 1063 patients were assessed.

Results: DPPHR was performed on 374 IPMN, 96 MCN, 154 SPN, 142 SCA, and 145 PNET patients. 90-day mortality was 5 of 1063 patients (0.47 %), pancreatic fistula B/C 15.7 %, biliary fistula 5.9 %. 39 of 228 IPMNs(17.1 %) revealed high-grade dysplasia, 10 of 374 IPMNs micro-carcinoma and 9 minimal invasive carcinoma. None of them developed disease recurrence after total DPPHR in the follow-up time of 42.05 months. 96.2 % of patients followed the postoperative tracking checks. Recurrent tumor, anastomotic or in remote pancreas, was observed in 21 of 374 IPMNs(5.61 %). Disease-specific survival for 2 and 5 years was 99.3 % and 97.3 %, respectively.

Conclusion: DPPHR for cystic neoplasms and PNETs is a low-risk surgical treatment and leads to cure of patients. Total duodenum- and CBD-preserving pancreatic head resection extends surgeons' skills for treatment of cystic, premalignant neoplasms of the pancreatic head.