Comparative Analysis of Duodenum-Preserving Pancreatic Head Resection and Pancreaticoduodenectomy
The treatment of benign and low-grade malignant diseases of the pancreatic head has been a subject of significant debate, particularly regarding the choice between duodenum-preserving pancreatic head resection (DPPHR) and pancreaticoduodenectomy (PD). This study aimed to compare the perioperative complications, safety, and long-term quality of life associated with these two surgical procedures.
The study was conducted at the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China, and included patients who underwent either DPPHR or PD between January 2014 and December 2018. A total of 99 patients were initially included, but 13 were lost to follow-up, leaving 86 patients for analysis. The inclusion criteria were patients aged 18 years or older with post-operative pathology results indicating chronic pancreatitis, benign diseases, or low-grade malignancy of the pancreatic head. Patients with a history of other tumors, medium- or high-grade malignancy, previous pancreatic surgery, incomplete clinical data, or a general worsening condition were excluded.
The patients were divided into two groups based on the surgical procedure they received: the DPPHR group (n = 29) and the PD group (n = 57). The DPPHR group included modifications such as the Beger, Berne, and Frey procedures, while the PD group involved the complete removal of the pancreatic head, uncinate process, duodenum, partial stomach, and common bile duct, followed by reconstruction through pancreaticojejunostomy, hepaticojejunostomy, and gastrojejunostomy.
The study collected general data on age, sex, body mass index (BMI), smoking and drinking habits, comorbid conditions (hypertension, diabetes), and specific symptoms (jaundice, pain, nausea, and vomiting). Long-term follow-up (≥1 year) included evaluations of quality of life using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (QLQ-C30) and nutritional status using the Nutrition Risk Screening 2002 tool. Post-operative complications such as diarrhea, fatty liver, new-onset diabetes, bile duct stones, cholangitis, anastomotic stricture, anastomotic calculi, and exocrine dysfunction were also recorded.
The results showed significant differences between the DPPHR and PD groups in several key areas. The operation time was shorter in the DPPHR group (493.45 ± 155.00 minutes) compared to the PD group (600.09 ± 140.72 minutes, P = 0.002). The duration of hospital stay was also shorter in the DPPHR group (24.55 ± 12.24 days) than in the PD group (31.37 ± 12.38 days, P = 0.018). Additionally, the cost of hospitalization was lower in the DPPHR group (94,300 ± 33,000 RMB yuan) compared to the PD group (128,200 ± 47,500 RMB yuan, P = 0.001).
Post-operative pancreatic exocrine insufficiency was significantly lower in the DPPHR group (6.9%) than in the PD group (36.8%, P = 0.007). Weight change post-operation was more favorable in the DPPHR group (3.00 [0.50–6.50] kg) compared to the PD group (0.00 [0.00–2.00] kg, P = 0.002). The cumulative long-term complications (≥3 months after surgery) were also lower in the DPPHR group (34.5%) than in the PD group (64.9%, P = 0.007).
Quality of life, as measured by the QLQ-C30 survey at one year post-operation, showed significant improvements in the DPPHR group compared to the PD group across all domains (all P < 0.05). This suggests that patients who underwent DPPHR experienced better overall health status and quality of life than those who underwent PD.
In conclusion, DPPHR offers several advantages over PD, including shorter operation times, reduced hospital stays, lower hospitalization costs, fewer post-operative complications, and improved quality of life. These benefits make DPPHR a preferable option for the treatment of benign and low-grade malignant diseases of the pancreatic head, achieving comparable surgical outcomes with fewer adverse effects.
doi.org/10.1097/CM9.0000000000000968
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