ObjectiveTo evaluate and synthesize the available experiences related to laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) in the management of benign pancreatic head lesions. MethodsA retrospective review of the clinical data was conducted for 12 patients who underwent LDPPHR at the Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Kunming Medical University (between January 2020 and December 2024). ResultsAll 12 patients successfully underwent LDPPHR. The surgical duration ranged from 138 to 479 min, with a mean of 336 min. Intraoperative blood loss varied between 40 and 700 mL, averaging 270 mL. The hospital stay varied from 11 to 51 d, with a mean duration of 21.5 d. Notably, none of the 12 patients required blood transfusions during the procedure. Of the 12 patients, 6 were diagnosed with a pancreatic fistula postoperatively, including 5 cases classified as grade A pancreatic fistula, and 1 cases of grade B pancreatic leakage. There were 2 cases of bile leakage and 1 case of gastric emptying disorder. No deaths occurred during the perioperative period. Postoperative pathological examination revealed: chronic pancreatitis witch main pancreatic duct stones in 8 cases, intraductal papillary mucinous neoplasms with low-grade epithelial intraepithelial neoplasia in 3 cases, serous cystadenoma in 1 case. Postoperative follow-up was conducted for 10 patients, with follow-up durations ranging from 6 to 24 months. No recurrence was observed during the follow-up period, and no long-term complications such as diabetes, gastric emptying dysfunction, etc. were reported. ConclusionsLDPPHR offers several benefits, including minimal invasiveness, faster recovery, and enhanced postoperative quality of life for patients. It is safe and feasible for the treatment of benign lesions in the head of the pancreas.
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.
Duodenum-preserving pancreatic head resection (DPPHR) is a surgical approach indicated for benign or low-grade malignant tumors of the pancreatic head, pancreatic duct stones in the pancreatic head, chronic pancreatitis, and related pathologies. Compared to traditional pancreaticoduodenectomy (PD), its core principle lies in preserving the integrity of the stomach, duodenum, and biliary tract, thereby reducing postoperative digestive dysfunction and metabolic complications to improve patients’ quality of life. With the continuous advancement of laparoscopic techniques, laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) has emerged as a significant refinement of conventional PD, achieving an optimal integration of minimally invasive laparoscopy and organ function preservation. This article synthesizes recent Chinese and English literature to provide a systematic review of surgical indications, technical nuances, complication management, and clinical outcomes of LDPPHR.