Surgery-Related Morbidity After Duodenum-Preserving Pancreatic Head Resection

Overview

This systematic review and meta-analysis evaluated early postoperative morbidity following duodenum-preserving pancreatic head resection (DPPHR) for benign and premalignant tumors. The study compared DPPHR with pancreatoduodenectomy (PD), focusing on severe surgery-related complications and in-hospital mortality. Findings suggest that DPPHR is associated with low rates of severe morbidity and mortality, supporting its use as a parenchyma-sparing alternative to PD.

Background

Pancreatoduodenectomy (PD) remains the standard surgical treatment for pancreatic head and periampullary cancers but carries significant risks including mortality and long-term metabolic dysfunction. Benign and premalignant pancreatic tumors are increasingly detected due to advanced imaging, leading to more surgeries in high-volume centers. Duodenum-preserving pancreatic head resection (DPPHR) offers preservation of duodenal and pancreatic tissue, potentially reducing postoperative endocrine and exocrine insufficiency. However, data on early postoperative morbidity after DPPHR have been limited, prompting this systematic review and meta-analysis.

Data Highlights

The review included 34 studies selected through a comprehensive search of PubMed/Medline, Embase, and Cochrane databases. Studies were assessed for methodological quality using the Critical Appraisal Skills Programme and Newcastle-Ottawa Scale, with only high-quality cohort studies included. Primary endpoints were severe surgery-related complications (Clavien-Dindo grade ≥ III) and in-hospital mortality.

Key Findings

• DPPHR demonstrated a low incidence of severe postoperative complications compared to PD in patients with benign and premalignant pancreatic head tumors.
• In-hospital mortality rates following DPPHR were minimal, supporting its safety profile.
• Preservation of the duodenum and pancreatic tissue in DPPHR contributed to lower rates of new-onset diabetes mellitus and pancreatic exocrine insufficiency compared to PD.
• High-quality evidence from included cohort studies supports the efficacy of DPPHR as a parenchyma-sparing surgical option.
• The systematic review highlighted the need for further prospective studies to confirm these findings and optimize patient selection.

Clinical Implications

DPPHR should be considered a viable surgical option for benign and premalignant tumors of the pancreatic head, offering reduced risk of severe postoperative morbidity and mortality compared to PD. Preservation of pancreatic and duodenal tissue may improve long-term endocrine and exocrine function, enhancing patient quality of life. Surgeons in high-volume centers may adopt DPPHR to balance oncologic control with functional preservation.

Conclusion

This systematic review and meta-analysis provide evidence that duodenum-preserving pancreatic head resection is a safe and effective procedure with low surgery-related morbidity and mortality for benign and premalignant pancreatic tumors. It represents a valuable parenchyma-sparing alternative to pancreatoduodenectomy.

References

1. Systematic Review and Meta-Analysis of Surgery-Related Morbidity Following Duodenum-Preserving Resection of the Pancreatic Head for Benign and Premalignant Tumors