Duodenum-preserving total pancreatic head resection for cystic neoplastic lesions in the head of the pancreas

Beger, H G; Gansauge, Frank; Siech, M.; Schwarz, Michael; Poch, Bertram

doi:10.1007/s00534-007-1227-4

Cited by 38 publications

(31 citation statements)

References 25 publications

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“…Considering the similarity of the histologic and biologic characteristics of adenomas in the other segments of the GI tract, such an adenoma-to-carcinoma carcinogenic process involving the rectum, ampulla, gallbladder, and biliary duct occurs within the biliary tract [27,28] . Therefore, complete resection of the lesion makes it possible to avoid development of carcinoma [29] . It is difficult to differentiate biliary adenomas from other malignant lesions with radiologic imaging [23] .…”

Section: Discussionmentioning

confidence: 99%

“…If malignancy is suspected or the size is larger than approximately 2 cm, radical resection is needed. We considered the other treatment option, duodenum preserving pancreatic head resection(DPPHR) which was first introduced by Beger et al [27] for chronic pancreatitis and has been increasingly used in neoplastic lesions, cystadenoma, borderline lesions, and carcinoma in situ [28][29][30] . However, we suspected that this tumor would be malignant and performed PPPD considering the size, site and clinical findings.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Carcinoma in situ arising in a tubulovillous adenoma of the distal common bile duct: A case report

Kim¹,

Joo²,

Joo³

2008

WJG

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Carcinoma in situ arising in a tubulovillous adenoma of the distal common bile duct: A case report

Kim¹,

Joo²,

Joo³

2008

WJG

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“…During resection of the head of the pancreas, therefore, it is absolutely essential to maintain the blood supply to the bile duct and the duodenum in order to prevent early postoperative complication [3,4,8]. DPPHR is technically difficult and time-consuming due to reconciling these antinomic techniques, namely, complete resection in the pancreatic head and preservation of both the bile duct and the pancreaticoduodenal vessels.…”

Section: Introductionmentioning

confidence: 99%

Surgical design and outcome of duodenum‐preserving pancreatic head resection for benign or low‐grade malignant tumors

Horiguchi

Miyakawa

Ishihara

et al. 2009

J Hepato Biliary Pancreat

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To apply duodenum-preserving pancreatic head resection (DPPHR) as radical procedure for benign or lowgrade malignant tumors, it needs the reconciliation of complete pancreatic head resection and preservation of the bile duct and peripancreatic vessels. Several modifications have been introduced and applied to remove these lesions, however, the techniques have not been made clear in the management of the peripancreatic vessels and the bile duct. The long-term outcomes of the DPPHR have been reported as extremely rare in comparison with pylorus preserving pancreatoduodenectomy (PPPD) in these pancreatic head tumors. The angiograms by multi-detector row CT (MD-CT) can be reconstructed more physiologically than selective angiography. The anterior arcade is predominant in 43% of 64 patients. Therefore, we modified the DPPHR to include a complete resection of the pancreatic head and the preservation of both anterior and posterior arterial arcades. The bile duct is covered by the pancreatic parenchyma in various ways. The techniques of the preservation of the bile duct are also introduced. We performed 21 DPPHRs and 19 PPPDs in the patients with benign or low-grade malignant pancreatic head tumor. There was no significant difference in operative factors. The postoperative death was one patient in PPPD, but none in DPPHR. The postoperative complications of PPPD were more often than that of DPPHR. There is no postoperative recurrence in DPPHR in the follow-up period from 2 to 216 months. Both exocrine and endocrine function and the long-term results following DPPHR were superior to those following PPPD. The DPPHR should be favored over the PPPD in benign or low-grade malignant tumors of the head of the pancreas if there is no compromise with oncologic radicality.

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“…However, for benign noncancerous neoplastic tumors, a limited organ-preserving pancreatic head resection has been introduced and increasingly used [5]. The duodenum-preserving total pancreatic head resection is a limited surgical procedure which preserves the duodenum, except a peripapillary segment, and conserves the endoand exocrine pancreatic functions [5].…”

Section: Introductionmentioning

confidence: 99%

Duodenum-preserving total pancreatic head resection for cystic neoplasm—a limited but cancer-preventive procedure

Beger

Rau

Gansauge

et al. 2008

Langenbecks Arch Surg

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A duodenum-preserving total pancreatic head resection is a limited surgical procedure for patients who suffer a local monocentric, cystic neoplastic lesion in the pancreatic head. Absence of an advanced pancreatic cancer and completeness of extirpation of the benign tumor determine the long-term outcome. In regards to the location of the lesion in the pancreatic head, several modifications have been applied with low hospital morbidity and mortality below 1%.

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Duodenum-preserving total pancreatic head resection for cystic neoplastic lesions in the head of the pancreas

Cited by 38 publications

References 25 publications

Carcinoma in situ arising in a tubulovillous adenoma of the distal common bile duct: A case report

Carcinoma in situ arising in a tubulovillous adenoma of the distal common bile duct: A case report

Surgical design and outcome of duodenum‐preserving pancreatic head resection for benign or low‐grade malignant tumors

Duodenum-preserving total pancreatic head resection for cystic neoplasm—a limited but cancer-preventive procedure

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