Laparoscopic duodenum-preserving pancreatic head resection

Zhou, Jiayu; Zhou, Yucheng; Mou, Yiping; Tao, Xin; Xu, Xiaorong; Jin, Weiwei; Zhang, Ren-Chao; Lü, Chao; Chen, Ronggao

doi:10.1097/md.0000000000004442

Cited by 13 publications

(7 citation statements)

References 12 publications

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“…Presently, only a few studies have reported LDPPHR based on surgical experience and case reports. In 2016, Zhou et al [ 15 ] reported the first case of LDPPHR for treating a solid pseudopapillary tumor present on the pancreatic head. In 2019, Cao et al [ 16 ] reported 12 patients who underwent LDPPHR for the treatment of benign and low-grade malignant tumors of the pancreatic head, which opened up a minimally invasive way for LDPPHR for treating benign or low-grade malignant tumors of the pancreatic head.…”

Section: Discussionmentioning

confidence: 99%

Short-term clinical outcomes of laparoscopic duodenum-preserving pancreatic head resection for the management of pancreatic-head cystic neoplasms

et al. 2023

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Background In this study, we aimed to investigate the short-term clinical outcomes of laparoscopic duodenum-preserving pancreatic-head resection (LDPPHR) for the management of pancreatic-head cystic neoplasms. Methods This retrospective study included 60 patients who were treated with pancreatic-head cystic neoplasms at the Shandong Provincial Hospital Affiliated to Shandong First Medical University from December 2019 to July 2022. Results No significant difference was found between the two groups in terms of the baseline and pathological characteristics of patients (P > 0.05). The postoperative exhaust time was shorter in the LDPPHR group compared with the laparoscopic pancreaticoduodenectomy (LPD) group (2 (2 and 4) vs. 4 (3 and 5) days; P = 0.003). No significant difference was found between the two groups in terms of operative time, estimated blood loss, intraoperative transfusion, hemoglobin levels on the first postoperative day, total bilirubin before discharge, direct bilirubin before discharge, postoperative hospital stay, postoperative pancreatic fistula, bile leakage, hemorrhage, peritoneal effusion, abdominal infection, delayed gastric emptying, interventional embolization hemostasis, reoperation, and 30-day readmission (P > 0.05). No conversion and 90-day mortality were found in the two groups. The LDPPHR group showed a higher 3-month postoperative PNI, 6-month postoperative TG and 6-month postoperative BMI than the LPD group (P < 0.05). Conclusions Compared with LPD, LDPPHR can decrease the postoperative exhaust time of patients, improve the short-term postoperative nutritional status, and does not decrease the safety of the perioperative period.

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Section: Discussionmentioning

confidence: 99%

Short-term clinical outcomes of laparoscopic duodenum-preserving pancreatic head resection for the management of pancreatic-head cystic neoplasms

et al. 2023

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“…DPPHR was initially introduced for chronic pancreatitis by Beger [6] and was proven to decrease the long-term endocrine and exocrine dysfunction compared with pancreaticoduodenectomy (PD) [2,3]. However, in terms of laparoscopic DPPHR, our team reported the first case in 2016 [7]; later on, a few studies reported 12-24 cases are complicated with astonishing biliary leakages of 4.5-16.7% without exception [8][9][10]. Moreover, none of them reported the long-term metabolic dysfunction, which was of great importance on deciding whether to perform L-DPPHR or not.…”

Section: Discussionmentioning

confidence: 99%

“…After the removal of the specimen, fluorescent cholangiography was also performed to detect the suspicious injury of the bile duct. Finally, a direct pancreaticogastrostomy or Roux-en-Y end-to-side pancreaticojejunostomy (duct to mucosa) was performed [7]. Two drainage tubes were placed behind the anastomosis.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…Duodenum-preserving pancreatic head resection (DPPHR) was first introduced by Beger in 1972 [6]. Attempts to perform Laparoscopic DPPHR(L-DPPHR) was made amidst the soaring passion for laparoscopic pancreatic surgery [7][8][9][10][11][12][13]. However, limited studies indicated alarming biliary leaks which varied from 11.8 to 16.7% [8][9][10][11][12][13], greatly restricting its applications because of the fear of injuring the invisible bile ducts embedded in the pancreas.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic duodenum–preserving pancreatic head resection with real-time indocyanine green guidance of different dosage and timing: enhanced safety with visualized biliary duct and its long-term metabolic morbidity

Lü

Mou

et al. 2022

Langenbecks Arch Surg

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Purpose Laparoscopic duodenum–preserving pancreatic head resection (L-DPPHR) is technically demanding with extreme difficulty in biliary preservation. Only a few reports of L-DPPHR are available with alarming bile leakage, and none of them revealed the long-term metabolic outcomes. For the first time, our study explored the different dosage and timing of indocyanine green (ICG) for guiding L-DPPHR and described the long-term metabolic results. Methods Between October 2015 and January 2021, different dosage and timing of ICG were administrated preoperatively and evaluated intra-operatively using Image J software to calculate the relative fluorescence intensity ratio of signal-to-noise contrast between bile duct and pancreas. Short-term complications and long-term metabolic disorder were collected in a prospectively maintained database and analyzed retrospectively. Results Twenty-five patients were enrolled without conversion to laparotomy or pancreaticoduodenectomy. Administrating a dosage of 0.5 mg/kg 24 h before the operation had the highest relative fluorescence intensity ratio of 19.3, and it proved to guide the biliary tract the best. Fifty-six percent of patients suffered from postoperative complications with 48% experiencing pancreatic fistula and 4% having bile leakage. No one suffered from the duodenal necrosis, and there was no mortality. When compared with the non-ICG group, the ICG group had a comparable diameter of tumor and similar safety distance from lesions to common bile duct; however, it decreased the incidence of bile leakage from 10% to none. The median length of hospital stay was 16 days. After a median follow-up of 26.6 months, no one had tumor recurrence or refractory cholangitis. No postoperative new onset of diabetes mellitus (pNODM) was observed, while pancreatic exocrine insufficiency (pPEI) and non-alcoholic fatty liver disease (NAFLD) were seen in 4% of patients 12 months after the L-DPPHR. Conclusion L-DPPHR is feasible and safe in selected patients, and real-time ICG imaging with proper dosage and timing may greatly facilitate the identification and the prevention of biliary injury. And it seemed to be oncological equivalent to PD with preservation of metabolic function without refractory cholangitis.

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“…Second, intraoperative blood loss less than OPD was 120 mL and no transfusion was found reducing the risks of PPC. [ 13 ]…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic pancreaticoduodenectomy in A-92-older Chinese patient for cancer of head of the pancreas

et al. 2017

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Introduction:Laparoscopic pancreaticoduodenectomy (LPD) is one of the most complex gastrointestinal procedures performed in laparoscopic abdominal surgery. However, the concern for elderly undergoing LPD remains. To the best of our knowledge, there are no reports describing LPD for A-92-older patient. This study aimed to share the experience of a tertiary pancreatic center and confirm the safety, feasibility of LPD for the elderly.Method:The patient had complained of 6-months history of abdominal discomfort and progressive jaundice. Abdominal computed tomography CT/MR imaging revealed a 3 × 3 cm solid hypovascular mass in the head of the pancreas. LPD was successfully performed after multidisciplinary team (MDT). Operation time was 450 minutes, and blood loss was 120 mL. Histological examination of the resected specimen confirmed the diagnosis of pancreatic ductal adenocarcinoma (PDAC).Outcomes:The patient was discharged on POD13 following an uneventful postoperative period. She was followed up 4 months without any sign of recurrence.Conclusion:LPD can be performed safely in patients of any age who are fit for surgery in specialist centers.

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Laparoscopic duodenum-preserving pancreatic head resection

Cited by 13 publications

References 12 publications

Short-term clinical outcomes of laparoscopic duodenum-preserving pancreatic head resection for the management of pancreatic-head cystic neoplasms

Short-term clinical outcomes of laparoscopic duodenum-preserving pancreatic head resection for the management of pancreatic-head cystic neoplasms

Laparoscopic duodenum–preserving pancreatic head resection with real-time indocyanine green guidance of different dosage and timing: enhanced safety with visualized biliary duct and its long-term metabolic morbidity

Laparoscopic pancreaticoduodenectomy in A-92-older Chinese patient for cancer of head of the pancreas

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