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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2021; 13(1): 30-49
Published online Jan 27, 2021. doi: 10.4240/wjgs.v13.i1.30
Pancreas-preserving duodenal resections vs pancreatoduodenectomy for groove pancreatitis. Should we revisit treatment algorithm for groove pancreatitis?
Vyacheslav Egorov, Roman Petrov, Aleksandr Schegolev, Elena Dubova, Andrey Vankovich, Eugeny Kondratyev, Andrey Dobriakov, Dmitry Kalinin, Natalia Schvetz, Elena Poputchikova
Vyacheslav Egorov, Roman Petrov, Department of Surgical Oncology, Ilyinskaya Hospital, Moscow 143421, Russia
Aleksandr Schegolev, V. I. Kulakov Research Center for Obstetrics, Ministry Hlth Russian Federat, VI Kulakov Res Ctr Obstet Gynecol & Perinatol, Moscow 119526, Russia
Elena Dubova, Department of Pathology, Buranazian Federal Medical and Biological Center of the Federal Medical and Biological Agency of Russian Federation, Moscow 143421, Russia
Andrey Vankovich, Department of HPB Surgery, Moscow Clinical Research Center, Moscow 111123, Russia
Eugeny Kondratyev, Department of Radiology, Vishnevsky Institute of Surgery, Ilyinskaya Hospital, Moscow 143421, Russia
Andrey Dobriakov, Natalia Schvetz, Elena Poputchikova, Department of Pathology, Bakhrushin Brothers Moscow City Hospital, Moscow 107076, Russia
Dmitry Kalinin, Department of Pathology, Vishnevsky Institute of Surgery, Ilyinskaya Hospital, Moscow 117997, Russia
Author contributions: Egorov V contributed to idea, surgery, acquisition, analysis and interpretation of data, writing the paper; Petrov R and Vankovich A contributed to surgery, acquisition, analysis and interpretation of data, paper revision; Kondratyev E contributed to acquisition, analysis and interpretation of radiological data, paper revision; Schegolev A, Dubova E, Dobriakov A, Kalinin D, Schvetz N, and Poputchikova E contributed to pathological examination, acquisition, analysis and interpretation of pathohistological data, paper revision.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Ilyinskaya Hospital, approval No. 03-01-SG/2020 of January 14, 2020.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Vyacheslav Egorov, MD, PhD, Associate Professor, Department of Surgical Oncology, Ilyinskaya Hospital, Rubliovskoye predmestiie 2-2, Moscow 143421, Russia.
egorov12333@gmail.com
Received: August 3, 2020
Peer-review started: August 3, 2020
First decision: September 17, 2020
Revised: September 22, 2020
Accepted: December 2, 2020
Article in press: December 2, 2020
Published online: January 27, 2021
Processing time: 164 Days and 0.8 Hours
BACKGROUND
The management of cystic dystrophy of the duodenal wall (CDDW), or groove pancreatitis (GP), remains controversial. Although pancreatoduodenectomy (PD) is considered the most suitable operation for CDDW, pancreas-preserving duodenal resection (PPDR) has also been suggested as an alternative for the pure form of GP (isolated CDDW). There are no studies comparing PD and PPDR for this disease.
AIM
To compare the safety, efficacy, and short- and long-term results of PD and PPDR in patients with CDDW.
METHODS
A retrospective analysis of the clinical, radiologic, pathologic, and intra- and postoperative data of 84 patients with CDDW (2004-2020) and a comparison of the safety and efficacy of PD and PPDR.
RESULTS
Symptoms included abdominal pain (100%), weight loss (76%), vomiting (30%) and jaundice (18%) and data from computed tomography, magnetic resonance imaging, and endoUS led to the correct preoperative diagnosis in 98.8% of cases. Twelve patients were treated conservatively with pancreaticoenterostomy (n = 8), duodenum-preserving pancreatic head resection (n = 6), PD (n = 44) and PPDR (n = 15) without mortality. Weight gain was significantly higher after PD and PPDR and complete pain control was achieved significantly more often after PPDR (93%) and PD (84%) compared to the other treatment modalities (18%). New onset diabetes mellitus and severe exocrine insufficiency occurred after PD (31% and 14%), but not after PPDR.
CONCLUSION
PPDR has similar safety and better efficacy than PD in patients with CDDW and may be the optimal procedure for the isolated form of CDDW. The pure form of GP is a duodenal disease and PD may be an overtreatment for this disease. Early detection of CDDW provides an opportunity for pancreas-preserving surgery.
Core Tip: This is a retrospective study that compared the safety, efficacy, short- and long-term results of pancreatoduodenectomy (PD) and pancreas-preserving duodenal resections (PPDR) in patients with groove pancreatitis (GP). Although PD is a conventional option for GP management, PPDR has been suggested as a treatment alternative for the pure form of GP in the early stage of this disease. Evaluation of these two treatment modalities has shown that PPDR for the pure form of GP is similar in terms of safety and better in efficacy compared to PD performed for GP. The key aim of this study is to demonstrate that PPDR may be the treatment of choice for the pure form of GP, which is a disease of the duodenum; early detection of GP makes preservation of the pancreas possible, and prolonged conservative treatment in early GP may lead to the development of segmental and diffuse pancreatitis, which may deprive patients of the pancreas-preserving option; PD is an overtreatment for the pure form of GP, since it involves resection of undamaged pancreas, which means that PPDR may be an alternative treatment procedure for GP.
