Pancreaticoduodenectomy for Benign Disease

ABSTRACT

BACKGROUND: Perioperative morbidity and mortality following a pancreaticoduodenectomy have decreased markedly over the last two decades, so many surgical centers advocate expanding the indications for a pancreaticoduodenectomy to include benign lesions other than periampullary malignancies. METHODS: Between 1990 and 1997, 22 patients underwent a pancreaticoduodenectomy (9 classical Whipple's operations, 10 pylorus-preserving pancreaticoduodenectomies and 3 duodenum preserving resection of the head of the pancreas) for benign disease from among a total of 306 patients receiving pancreaticoduodenectomy. The postoperative morbidity and mortality were analyzed retrospectively. RESULTS: The sites of the lesions were the pancreatic head (n=12), the common bile duct (n=5), the duodenum (n=3) and the ampulla of Vater (n=2). The most frequent indication for pancreaticoduodenectomy was a suspicion of malignancy. There was no immediate postoperative mortality, and perioperative complications occurred in 50% of the patients (11/22 patients). During the follow-up period (mean follow-up 23.8 month), there were no complications or mortalities related to either disease or the operation. CONCLUSIONS: This study suggests that a pancreaticoduodenectomy should be recommended for periampullary benign disease if malignancy cannot be excluded or if the lesion cannot be removed without the procedure. However, perioperative morbidity and mortality are still higher for a pancreaticoduodenectomy than for other procedures, so patient selection and perioperative management should be careful, also, a more conservative procedure than the classical Whipple's operation should be considered for benign lesions, if possible, for better quality of life.