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Intracapsular approach used in laparoscopic duodenum-preserving total pancreatic head resection for pancreatic head benign or low-grade malignant tumors

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Abstract

Purpose

Laparoscopic duodenum-preserving total pancreatic head resection (LDPPHRt) is used for treating benign or low-grade malignant tumors of the pancreatic head. However, preservation of the duodenum and biliary tract integrity remains challenging. We present a new approach for LDPPHRt and evaluate its feasibility and safety.

Methods

From April 2020 to December 2020, 30 patients successfully underwent LDPPHRt using the intracapsular approach in our center. Their medical records were reviewed for relevant clinical characteristics, pathologic findings, postoperative complications, and survival.

Results

The median diameter of the lesions was 3.6 cm (range, 2.0–5.5 cm). The median operative time was 234.7 min (range, 195–310 min). The median blood loss was 66.7 ml (range, 20–250 ml). The morbidity rate was 26.7%, including POPF, hemorrhage, lymphatic leakage, wound infection, pulmonary infection, and delayed gastric emptying. Five patients developed pancreatic fistula type A, and two patients had type B, classified according to the International Study Group on Pancreatic Fistula. No biliary tract injury or duodenal leakage was observed. The median postoperative hospital stay was 11.5 days (range, 6–25), and the operative mortality rate was 0%.

Conclusion

The intracapsular approach is a feasible and safe surgical procedure in LDPPHRt for patients with benign or low-grade malignant tumors, especially those without severe pancreatic head fibrosis or peripancreatic adhesions.

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Acknowledgements

I would like to express my sincere thanks to all those who have lent me hands in the course of my writing this paper. First of all, I would like to take this opportunity to show my sincere gratitude to my supervisor, Dr. Renyi Qin, who has designed this research with given me very useful advice. Second, I would like to express my gratitude to my colleagues, Dr. Yang Gao, who performed data statistics on time. Without their help, it would be much harder for me to finish my study. Finally, we would like to thank Editage (www.editage.com) for English language editing.

Funding

This study was supported by grants from the National Natural Science Foundation of China (81772950 and 82073249 to RYQ, 81773160 to MW, 81874205 to FZ, and 81702792 to SMX), Tongji Hospital Clinical Research Flagship Program (2019CR203 to RYQ), Hubei Natural Science Foundation (2017CFB467 to RYQ, WJ2017Z010 to YHY), National Key Research and Development Program of China (2019TFC1315905), and Tongji Hospital Science Fund for Distinguished Young Scholars (2017).

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Author notes

  1. Min Zhou and Simiao Xu contributed equally to this work.

Authors and Affiliations

  1. Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China

    Min Zhou, Dang Chao, Min Wang, Feng Zhu, Feng Peng, Hang Zhang, Xingjun Guo, Xu Li, Ruizhi He, Jikuan Jin, Yi Wu, Yang Gao, Yechen Feng & Renyi Qin

  2. Department of Endocrinology, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China

    Simiao Xu

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  1. Min Zhou
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Corresponding authors

Correspondence to Yang Gao, Yechen Feng or Renyi Qin.

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Zhou, M., Xu, S., Chao, D. et al. Intracapsular approach used in laparoscopic duodenum-preserving total pancreatic head resection for pancreatic head benign or low-grade malignant tumors. Langenbecks Arch Surg 407, 3851–3858 (2022). https://doi.org/10.1007/s00423-022-02509-5

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