ObjectiveTo review the current clinical application of Beger procedure and Frey procedure for benign disease or low-grade malignant potential lesion of pancreas. MethodsRelevant literatures about current advance of clinical application of Beger procedure and Frey procedure published recently of domestic and abroad were collected and reviewed. ResultsWith the concept of organ-preserving operations was adopted in recent years, Beger procedure and Frey procedure were applied generally. Beger procedure and Frey procedure were associated with tolerable perioperative risk, postoperative complications, and good outcomes in the aspects of preservation of function and curability in these lesions compared to conventional pancreatectomy, with preservation of the physiological food passage, thus patients gained weight faster, had less pain, and demonstrated better exocrine and endocrine pancreatic function postoperatively and an improvement in the quality of life. Both procedures had reached an international position as a standard operation for the treatment of benign disease or low-grade malignant potential lesion of pancreas. But after long-term following-up early advantages were no longer present. ConclusionsBeger procedure and Frey procedure are safe and effective in providing good outcomes in the aspects of preservation of function and curability in benign disease or low-grade malignant potential lesion of pancreas. Organ-preserving pancreatectomy could become a new organ-preserving standard operation.
ObjectiveTo summarize of clinical application and progress of duodenum-preserving pancreatic head resection (DPPHR).MethodThe relevant literatures published recently at domestic and abroad about the clinical application and progress of DPPHR were collected and reviewed.ResultsFor the benign lesions, low-grade malignancies and borderline tumors of the head of pancreas, the DPPHR could achieve the same expected therapeutic effect as the classical pancreatoduodenectomy. The DPPHR could reserve the continuity of stomach and duodenum while resecting lesions and improve the symptoms of patients, reduce the reconstruction of digestive tract and the resection of pancreas and surrounding tissues as much as possible, and retain the pancreas-intestinal axis, which was more in line with the physiology of human beings.ConclusionsAt present, DPPHR is worthy of further development and promotion in department of pancreas surgery, but current studies only focus on occurrence of short-term complications after operation. Because patients with benign diseases of pancreatic head have better prognosis and longer survival time after operation, we should pay attention to the long-term complications such as diarrhea, anemia and reflux cholangitis. More clinical studies need in future to be demonstrated superiority of DPPHR in clinical efficacy and to evaluate occurrence of long-term complications and their impact on quality of life of patients with DPPHR by comprehensive analysis of multiple evaluation indicators.
ObjectiveTo summarize and analyze the long-term clinical effect of duodenum-preserving pancreatic head resection (DPPHR) versus pancreaticoduodenectomy.MethodsThe clinical data of 102 patients who underwent DPPHR (n=35) or pancreaticoduodenectomy (n=67) from January 2014 to December 2019 in The First Affiliated Hospital of Xinjiang Medical University were analyzed retrospectively.ResultsThe operations of patients in the DPPHR group and the PD group were successfully complete, no one died during operation or perioperative period. The weight gain in one year after operation and incidences of exocrine dysfunction in the DPPHR group were all better than those of the PD group (P<0.05), but there was no significant difference on the other complications between the two groups (P>0.05). The pain score, diarrhea score, and the overall health status score in one year after operation significantly improved in the DPPHR group than those in the PD group (P<0.05).ConclusionDPPHR is more beneficial to improve the quality of life after operation, and is a better surgical procedure for benign and low-grade malignant diseases of pancreatic head.
Objective To summarize the preoperative CT three-dimensional reconstruction, and administration and visualization of indocyanine green (ICG) during ICG-assisted laparoscopic duodenum-preserving pancreatic head resection (LDPPHR). Methods A 56-year-old female patient admitted to the Department of Biliary Surgery in West China Hospital in April 2022 was retrospectively analyzed. The patient was considered the possibility of benign tumor of pancreatic head, and underwent LDPPHR. Three-dimensional CT reconstruction was performed before operation, and ICG (5 mg) was injected intravenously preoperative and intraoperative to complete LDPPHR. Results Preoperative three-dimensional CT reconstruction can assist in judging the course and relationship of anterior and posterior pancreaticoduodenal arterial arch and surrounding main blood vessels. After intravenous injection of 5 mg ICG 24 hours before operation, the common bile duct at the upper edge of pancreas was clearly visualized, and the cystic mass was judged not to communicate with bile duct and pancreatic duct. But it was difficult to identify the pancreatic segment of the common bile duct in fluorescence mode, ICG 5 mg was injected intravenously during the resection stage, and then the common bile duct was obviously visualized. After the resection stage, injected ICG (5 mg) intravenously again. Within 1 min, the fluorescence of the duodenum was enhanced, which suggested that the blood perfusion of duodenum was well. The operative time was 280 min, the blood loss was about 200 mL. On the 10th day after operation, the patient developed transient gastrointestinal bleeding with bile leakage, which improved after symptomatic treatment and was discharged on the 19th day. Postoperative pathological examination diagnosed pancreatic serous cystadenoma. Conclusions Three-dimensional reconstruction and ICG assisted LPDDHR can successfully visualize and identify the blood vessels and bile ducts, and check the duodenal blood perfusion. Which can making the operation more accurate and visual is a powerful guarantee for LDPPHR to be carried out safely and effectively.
ObjectiveTo compare the perioperative outcomes of laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) and minimally invasive enucleation (MIEN) in the treatment of benign or low-grade malignant tumors of the pancreatic head. MethodsA retrospective analysis was conducted on the clinical data of patients who underwent LDPPHR (n=30) and MIEN (n=38) at Fudan University Shanghai Cancer Center between March 2021 and November 2024. The perioperative outcomes of the LDPPHR and MIEN groups were compared. Preoperative assessment of tumors in the MIEN group showed that they were partially or completely encircling the main pancreatic duct. ResultsThe MIEN group had a significantly shorter operative time compared to the LDPPHR group (229.0 min vs. 388.5 min, P<0.001), with less intraoperative blood loss (100.0 mL vs. 200.0 mL, P=0.028). Regarding the management of the main pancreatic duct, 26.3% (10/38) of patients in the MIEN group had an intact and unexposed main pancreatic duct, 10.5% (4/38) had exposed but undamaged ducts, 7.9% (3/38) had duct injury repaired with simple suture, and 55.3% (21/38) required stenting for duct repair and reconstruction following injury. Although the incidence of postoperative pancreatic fistula was higher in the MIEN group compared to the LDPPHR group [grade B: 73.7% (28/38) vs. 43.3% (13/30)], no significant differences were observed between the two groups in other perioperative outcomes (such as postoperative length of stay, discharge rate with drainage tube, and Clavien-Dindo complication grading, all P>0.05). One patient in the MIEN group required reoperation due to early postoperative hemorrhage. ConclusionsMIEN is a feasible surgical option for treating benign or low-grade malignant pancreatic head tumors with involvement of the main pancreatic duct. It shows significant advantages, particularly in terms of preserving organ function and maintaining normal anatomical structures. Despite the higher incidence of pancreatic fistula, no significant differences were observed in other perioperative outcomes compared to LDPPHR. Therefore, MIEN holds great promise in the treatment of pancreatic head tumors, especially for younger patients with a strong desire for function preservation.