Beger Hans G, Mayer Benjamin, Rau Bettina M
c/o University of Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany.
Department of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
J Gastrointest Surg. 2016 Jan;20(1):206-17. doi: 10.1007/s11605-015-2981-2. Epub 2015 Nov 2.
Parenchyma-sparing local extirpation of benign tumors of the pancreatic head provides the potential benefits of preservation of functional tissue and low postoperative morbidity.
Medline/PubMed, Embase, and Cochrane library databases were surveyed for studies performing limited resection of the pancreatic head and resection of a segment of the duodenum and common bile duct or preservation of the duodenum and common bile duct (CBD). The systematic analysis included 27 cohort studies that reported on limited pancreatic head resections for benign tumors. In a subgroup analysis, 12 of the cohort studies were additionally evaluated to compare the postoperative morbidity after total head resection including duodenal segment resection (DPPHR-S) and total head resection conserving duodenum and CBD (DPPHR-T).
Three hundred thirty-nine of a total of 503 patients (67.4%) underwent total head resections. One hundred forty-seven patients (29.2%) of them underwent segmental resection of the duodenum and CBD (DPPHR-S) and 192 patients (38.2%) underwent preservation of duodenum and CBD. One hundred sixty-four patients experienced partial head resection (32.6%). The final histological diagnosis revealed in 338 of 503 patients (67.2%) cystic neoplasms, 53 patients (10.3%) neuroendocrine tumors, and 20 patients (4.0%) low-risk periampullary carcinomas. Severe postoperative complications occurred in 62 of 490 patients (12.7%), pancreatic fistula B + C in 40 of 295 patients (13.6%), resurgery was experienced in 2.7%, and delayed gastric emptying in 12.3%. The 90-day mortality was 0.4%. The subgroup analysis comparing 143 DPPHR-S patients with 95 DPPHR-T patients showed that the respective rates of procedure-related biliary complications were 0.7% (1 of 143 patients) versus 8.4% (8 of 95 patients) (p ≤ 0.0032), and rates of duodenal complications were 0 versus 6.3% (6 of 95 patients) (p ≤ 0.0037). DPPHR-S was associated with a higher rate of delay of gastric emptying compared to DPPHR-T (18.9 vs. 2.1%, p ≤ 0.0001).
Parenchyma-sparing, limited head resection for benign tumors preserves functional pancreatic and duodenal tissue and carries in terms of fistula B + C rate, resurgery, rehospitalization, and 90-day mortality a low risk of postoperative complications. A subgroup analysis exhibited after total pancreatic head resection that preserves the duodenum and CBD an association with a significant increase in procedure-related biliary and duodenal complications compared to total head resection combined with resection of the periampullary segment of the duodenum and resection of the intrapancreatic CBD.
保留实质的胰头良性肿瘤局部切除可带来保留功能组织及降低术后发病率的潜在益处。
检索Medline/PubMed、Embase和Cochrane图书馆数据库，查找有关胰头有限切除以及十二指肠和胆总管部分切除或保留十二指肠和胆总管（CBD）的研究。系统分析纳入了27项队列研究，这些研究报告了针对良性肿瘤的胰头有限切除情况。在亚组分析中，另外评估了12项队列研究，以比较包括十二指肠段切除的全胰头切除（DPPHR-S）和保留十二指肠及CBD的全胰头切除（DPPHR-T）后的术后发病率。
503例患者中，339例（67.4%）接受了全胰头切除。其中147例患者（29.2%）接受了十二指肠和CBD的节段性切除（DPPHR-S），192例患者（38.2%）接受了十二指肠和CBD的保留。164例患者接受了部分胰头切除（32.6%）。503例患者中的338例（67.2%）最终组织学诊断为囊性肿瘤，53例患者（10.3%）为神经内分泌肿瘤，20例患者（4.0%）为低风险壶腹周围癌。490例患者中有62例（12.7%）发生严重术后并发症，295例患者中有40例（13.6%）发生B+C级胰瘘，2.7%的患者接受了再次手术，12.3%的患者出现胃排空延迟。90天死亡率为0.4%。比较143例DPPHR-S患者和95例DPPHR-T患者的亚组分析显示，与手术相关的胆道并发症发生率分别为0.7%（143例患者中的1例）和8.4%（95例患者中的8例）（p≤0.0032），十二指肠并发症发生率分别为0和6.3%（95例患者中的6例）（p≤0.0037）。与DPPHR-T相比，DPPHR-S的胃排空延迟发生率更高（18.9%对2.1%，p≤0.0001）。
保留实质的胰头良性肿瘤有限切除可保留功能性胰腺和十二指肠组织，就B+C级胰瘘发生率、再次手术、再次住院和90天死亡率而言，术后并发症风险较低。亚组分析显示，与全胰头切除联合十二指肠壶腹周围段切除及胰内CBD切除相比，保留十二指肠和CBD的全胰头切除与手术相关的胆道和十二指肠并发症显著增加相关。
