Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, P.R. China.
BMC Surg. 2023 Sep 21;23(1):288. doi: 10.1186/s12893-023-02170-9.
The procedure of total duodenum-preserving pancreatic head resection (DPPHRt) has been reported frequently, but rare in minimally invasive procedure, especially robotic-assisted operation. Here we share our experience and analyze the clinical outcomes of minimally invasive DPPHRt in the treatment of benign lesions or low-grade malignant tumors of the pancreatic head in this study.
From October 2016 to January 2022, three patients received robot-assisted DPPHRt(RA-DPPHRt), and seventeen patients received laparoscopic DPPHRt(LDPPHRt). Data were retrospectively collected in terms of demographic characteristics (age, gender, body mass index, and pathological diagnosis), intraoperative variables (operative time, estimated blood loss), and post-operative variables (post-operative hospital stay, and complications).
All 20 patients received minimally invasive total duodenum-preserving pancreatic head resection successfully without conversion, including 8 males and 12 females. Pathological diagnosis suggested 1 case of serous cystadenoma (SCA), 4 cases of intraductal papillary mucinous neoplasm (IPMN) ,5 cases of mucinous cystic neoplasm (MCN), 4 cases of pancreatic neuroendocrine neoplasm (PNET), 2 cases of chronic pancreatitis (CP),4 case of solid pseudopapillary tumor (SPT). The average operation time was (285.35 ± 95.13 min), ranging from 95 to 420 min. The average estimate blood loss was (196.50 ± 174.45ml) ,ranging from 10 to 600ml.The average post-operative hospital stay was(20.90 ± 14.44days),ranging from 8 to 54 days. Postoperative complications occurred in 10 patients (50%). A total of 5 patients (20%) suffered grade B or C pancreatic fistula. Two patients (10%) suffered from biliary fistula. Two patients (10%) suffered from delayed gastric emptying. One patient (5%) suffered from abdominal bleeding. The 90-day mortality was 0. No patient was observed tumor recurrence and new-onset diabetes but one developed diarrhea.
RA-DPPHRt or LDPPHRt provided a minimally invasive approach with good organ-preservation for patients with benign and low-grade malignant pancreatic head tumor. It is only recommended to be performed in high-volume pancreatic centers by experienced pancreatic surgeons.
全胰十二指肠切除术（DPPHRt）的手术方式已被广泛报道，但在微创治疗中，尤其是机器人辅助手术中，报道较少。在此，我们分享我们的经验，并分析这项研究中微创 DPPHRt 治疗胰腺头部良性病变或低级别恶性肿瘤的临床结果。
自 2016 年 10 月至 2022 年 1 月，3 名患者接受了机器人辅助 DPPHRt（RA-DPPHRt），17 名患者接受了腹腔镜 DPPHRt（LDPPHRt）。收集了患者的人口统计学特征（年龄、性别、体重指数和病理诊断）、术中变量（手术时间、估计失血量）和术后变量（术后住院时间和并发症）等数据。
所有 20 名患者均成功接受了微创全胰十二指肠保留胰腺头部切除术，无中转开腹，其中男 8 例，女 12 例。病理诊断提示浆液性囊腺瘤 1 例，胰管内乳头状黏液性肿瘤 4 例，黏液性囊腺瘤 5 例，胰腺神经内分泌肿瘤 4 例，慢性胰腺炎 2 例，实性假乳头状瘤 4 例。平均手术时间为（285.35±95.13）min，范围为 95420min。平均估计出血量为（196.50±174.45）ml，范围为 10600ml。平均术后住院时间为（20.90±14.44）d，范围为 8~54d。术后发生并发症 10 例（50%）。其中 5 例（20%）发生 B 级或 C 级胰瘘，2 例（10%）发生胆瘘，2 例（10%）发生胃排空延迟，1 例（5%）发生腹腔出血。90 天死亡率为 0%。无患者出现肿瘤复发和新发糖尿病，但有 1 例出现腹泻。
RA-DPPHRt 或 LDPPHRt 为胰腺头部良性和低级别恶性肿瘤患者提供了一种微创保留器官的方法。仅推荐由经验丰富的胰腺外科医生在高容量胰腺中心进行。
