Clinical feasibility of duodenum-preserving pancreatic head resection for neuroendocrine tumors of the pancreatic head as an intermediate procedure between enucleation and pancreaticoduodenectomy

TL;DR

This study shows that a new surgical method for pancreatic tumors preserves the duodenum and offers good outcomes for patients.

Contribution

The study demonstrates the clinical feasibility of DPPHR as an alternative to traditional surgeries for pancreatic neuroendocrine tumors.

Findings

All patients achieved curative resection with no positive tumor margins.

Postoperative complications were minimal, with only one case of intra-abdominal bleeding.

No patients experienced lymph node metastasis or recurrence during follow-up.

Abstract

This study was performed to demonstrate the clinical application of duodenum-preserving pancreatic head resection (DPPHR) as a surgical treatment for pancreatic neuroendocrine tumors (PNETs) in terms of both curability and maintenance of postoperative quality of life.

Seven patients diagnosed with PNETs underwent DPPHR from January 2011 to December 2021 at our institution. We investigated the clinical relevance of DPPHR based on the patients’ clinicopathological findings.

The median operative time was 492 min, and the median blood loss was 302 g. Postoperative complications were evaluated according to the Clavien–Dindo classification, and postoperative intra-abdominal bleeding was observed in one patient. Pathological examination revealed a World Health Organization classification of G1 in six patients and G2 in one patient. Microvascular invasion was observed in two patients (29%); however, no patients developed lymph node metastasis or recurrence during the follow-up period. A daughter lesion was observed near the primary tumor in one patient. All patients achieved curative resection, and no tumor specimens showed positive margins.

DPPHR facilitates anatomical resection of the pancreatic head in patients with PNETs as well as detailed pathological evaluation of the resected specimen. Therefore, this surgical procedure is an acceptable alternative to pancreaticoduodenectomy or enucleation for patients with PNETs.

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