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.

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.