Duodenumerhaltende totale Pankreaskopfresektion

Abstract

Cystic neoplasms of the pancreas are being detected and surgically treated increasingly more frequently. Intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN) are primary benign lesions; however, the 5-year risk for malignant transformation has been estimated to be 63 % and 15 %, respectively. Surgical extirpation of a benign cystic tumor of the pancreas is a cancer preventive measure. The duodenum-preserving total pancreatic head resection technique (DPPHRt) is being used more frequently for cystic neoplasms of the pancreatic head. The complete resection of the pancreatic head can be applied as a duodenum-preserving technique or with segmental resection of the peripapillary duodenum. Borderline lesions, carcinoma in situ or T1N0 cancer of the papilla and the peripapillary common bile duct are also considered to be indications for segmental resection of the peripapillary duodenum. A literature search for cystic neoplastic lesions and DPPHRt revealed the most frequent indications to be IPMN, MCN and SCA lesions and 28 % suffered from a cystic neoplasm with carcinoma in situ or a peripapillary malignoma. The hospital mortality rate was 0.52 %. Compared to the Whipple type resection the DPPHRt exhibits significant benefits with respect to a low risk for early postoperative complications and a low hospital mortality rate of < 1 %. Exocrine and endocrine pancreatic functions after DPPHR are not impaired compared to the Whipple type resection.

Pancreatic head resection with segmental duodenectomy for the treatment of benign and malign pancreatic diseases. Case series experience of a single center

“…One of the DPPHR procedures introduced by Beger et al [5] involves dividing the pancreas at the level of the portal vein, detaching the pancreatic head without completely removing it, and then reconstructing the area with two anastomoses to drain the pancreatic remnant and cover the defect in the pancreatic head. The common bile duct may also be drained if necessary.…”

Laparoscopic duodenum-preserving pancreatic head resection

“…In the 1970s, Beger et al [1] developed duodenum-preserving pancreatic head resection (DPPHR) for patients with an inflammatory mass in the head of the pancreas caused by chronic pancreatitis. Compared with pancreaticoduodenectomy, the Beger procedure maintained the integrity of the duodenum and biliary tract.…”