Clinical feasibility of duodenum-preserving pancreatic head resection for neuroendocrine tumors of the pancreatic head as intermediate procedure between enucleation and pancreaticoduodenectomy

Background: This study aimed to demonstrate the clinical application of duodenum-preserving pancreatic head resection (DPPHR) as a surgical treatment for pancreatic neuroendocrine tumors (PNETs) in terms of both curability and maintenance of postoperative quality of life. Methods: A total of seven patients diagnosed with PNET underwent DPPHR between January 2011 and December 2021 at our institution. We investigated the clinical relevance of DPPHR based on clinicopathological findings in patients who underwent the surgery. Results: Median operative time was 492 min, and blood loss was 302 g. In terms of postoperative complications according to Clavien-Dindo classification, postoperative intraabdominal bleeding was seen in one patient. Pathological examination revealed WHO classification of G1 in 6 cases and G2 in one case. Microvascular invasion (MVI) was observed in two cases (29%), however, no lymph node metastasis or recurrence occurred during the follow-up period. A daughter lesion was observed near the primary tumor in one case. All patients achieved curative resection, and none of the cases showed positive margins. Conclusions: DPPHR allows anatomical resection of the pancreatic head in patients with PNETs, and also facilitates detailed pathological evaluation of the resected specimen. Therefore, this surgical procedure is an acceptable alternative to pancreaticoduodenectomy or enucleation for patients with PNETs.