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Journal of Gastrointestinal Surgery

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01-11-2012 | How I do it

Duodenum-Preserving Total Pancreatic Head Resection for Benign Cystic Neoplastic Lesions

Authors: Hans G. Beger, Michael Schwarz, Bertram Poch

Published in: Journal of Gastrointestinal Surgery | Issue 11/2012

Abstract

Background

Cystic neoplasms of the pancreas are diagnosed frequently due to early use of abdominal imaging techniques. Intraductal papillary mucinous neoplasm, mucinous cystic neoplasm, and serous pseudopapillary neoplasia are considered pre-cancerous lesions because of frequent transformation to cancer. Complete surgical resection of the benign lesion is a pancreatic cancer preventive treatment.

Objectives

The application for a limited surgical resection for the benign lesions is increasingly used to reduce the surgical trauma with a short- and long-term benefit compared to major surgical procedures. Duodenum-preserving total pancreatic head resection introduced for inflammatory tumors in the pancreatic head transfers to the patient with a benign cystic lesion located in the pancreatic head, the advantages of a minimalized surgical treatment.

Patients

Based on the experience of 17 patients treated for cystic neoplastic lesions with duodenum-preserving total pancreatic head resection, the surgical technique of total pancreatic head resection for adenoma, borderline tumors, and carcinoma in situ of cystic neoplasm is presented. A segmental resection of the peripapillary duodenum is recommended in case of suspected tissue ischemia of the peripapillary duodenum. In 305 patients, collected from the literature by PubMed search, in about 40% of the patients a segmental resection of the duodenum and 60% a duodenum and common bile duct-preserving total pancreatic head resection has been performed.

Results

Hospital mortality of the 17 patients was 0%. In 305 patients collected, the hospital mortality was 0.65%, 13.2% experienced a delay of gastric emptying and a pancreatic fistula in 18.2%. Recurrence of the disease was 1.5%. Thirty-two of 175 patients had carcinoma in situ.

Conclusion

Duodenum-preserving total pancreatic head resection for benign cystic neoplastic lesions is a safe surgical procedure with low post-operative morbidity and mortality.

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Title: Duodenum-Preserving Total Pancreatic Head Resection for Benign Cystic Neoplastic Lesions
Authors: Hans G. Beger
Michael Schwarz
Bertram Poch
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 11/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-1929-z

At a glance: The STEP trials

Springer Medicine

Duodenum-Preserving Total Pancreatic Head Resection for Benign Cystic Neoplastic Lesions

Abstract

Background

Objectives

Patients

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objectives

Patients

Results

Conclusion

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