LI Zheng , SHI Yihua , LIU Wensheng , ZHUO Qifeng , JI Shunrong , ZHOU Chenjie , YU Xianjun , XU Xiaowu
  • Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University; Shanghai Pancreatic Cancer Institute; Shanghai Key Laboratory of Precision Medicine for Pancreatic Cancer; Pancreatic Cancer Institute, Fudan University, Shanghai 200032, P. R. China;
XU Xiaowu, Email: xuxiaowu@fudanpci.org
pancreatic head tumor; duodenum-preserving pancreatic head resection; minimally invasive enucleation; main pancreatic duct repair and reconstruction; perioperative prognosis
10.7507/1007-9424.202501036
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Objective To compare the perioperative outcomes of laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) and minimally invasive enucleation (MIEN) in the treatment of benign or low-grade malignant tumors of the pancreatic head. Methods A retrospective analysis was conducted on the clinical data of patients who underwent LDPPHR (n=30) and MIEN (n=38) at Fudan University Shanghai Cancer Center between March 2021 and November 2024. The perioperative outcomes of the LDPPHR and MIEN groups were compared. Preoperative assessment of tumors in the MIEN group showed that they were partially or completely encircling the main pancreatic duct. Results The MIEN group had a significantly shorter operative time compared to the LDPPHR group (229.0 vs. 388.5 min, P<0.001), with less intraoperative blood loss (100.0 vs. 200.0 mL, P=0.028). Regarding the management of the main pancreatic duct, 26.3% (10/38) of patients in the MIEN group had an intact and unexposed main pancreatic duct, 10.5% (4/38) had exposed but undamaged ducts, 7.9% (3/38) had duct injury repaired with simple suture, and 55.3% (21/38) required stenting for duct repair and reconstruction following injury. Although the incidence of postoperative pancreatic fistula was higher in the MIEN group compared to the LDPPHR group (73.7% vs. 43.3%, P=0.022), no significant differences were observed between the two groups in other perioperative outcomes (such as postoperative length of stay, discharge rate with drainage tube, and Clavien-Dindo complication grading, all P>0.05). One patient in the MIEN group required reoperation due to early postoperative hemorrhage. Conclusions MIEN is a feasible surgical option for treating benign or low-grade malignant pancreatic head tumors with involvement of the main pancreatic duct. It shows significant advantages, particularly in terms of preserving organ function and maintaining normal anatomical structures. Despite the higher incidence of pancreatic fistula, no significant differences were observed in other perioperative outcomes compared to LDPPHR. Therefore, MIEN holds great promise in the treatment of pancreatic head tumors, especially for younger patients with a strong desire for function preservation.

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