Pancreas preserving duodenectomy (PPrD)

Am J Surg. 2024 Nov:237:115746. doi: 10.1016/j.amjsurg.2024.04.017. Epub 2024 Apr 16.

Abstract

Background: Pancreaticoduodenectomy has been the standard of care for managing duodenal neoplasms, but recent studies show similar overall and disease-specific survival after pancreas-preserving duodenectomy (PPrD) with potentially less morbidity.

Methods: Retrospective cohort of all adult (age >18) patients who underwent PPrD with curative intent of a neoplasm in or invading into the duodenum at our institution from 2011 to 2022 (n ​= ​29), excluding tumors involving the Ampulla of Vater or the pancreas. Statistical analyses were performed using STATA.

Results: R0 resection was achieved in 93 ​% patients. Ten (34.4 ​%) experienced postoperative complications (13.7 ​% within Clavien-Dindo III-V). PPrD patients had lower rates of pancreatic leak, delayed gastric emptying, and deep surgical site infection.

Conclusions: In this case series, we demonstrate PPrD is safe and effective, with a high rate of complete resection and lower complication rate than that seen in pancreaticoduodenectomy.

Keywords: Non-ampullary duodenal neoplasms; Pancreas-preserving duodenectomy; Pancreaticoduodenectomy.

MeSH terms

  • Adult
  • Aged
  • Duodenal Neoplasms* / pathology
  • Duodenal Neoplasms* / surgery
  • Duodenum / surgery
  • Female
  • Humans
  • Male
  • Middle Aged
  • Organ Sparing Treatments / methods
  • Pancreas / surgery
  • Pancreaticoduodenectomy / adverse effects
  • Pancreaticoduodenectomy / methods
  • Postoperative Complications* / epidemiology
  • Retrospective Studies
  • Treatment Outcome