Pancreas-preserving duodenal resections as a surgery of choice for the isolated form of cystic dystrophy of the duodenal wall (pure form of groove pancreatitis)

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Abstract

Background: Management of the isolated form of cystic dystrophy of the duodenal wall (CDDW), or pure form of groove pancreatitis, is controversial. Pancreatoduodenectomy is considered to be the most suitable procedure for CDDW. Pancreas-preserving procedures (PPDR) have been described as surgical options for the cases where only the duodenum has been involved. There are no studies comparing pancreas-preserving vs. pancreas-resecting procedures for this disease.

Aim: To analyze the results and outcomes of PPDR and other treatment approaches to CDDW and to review the literature.

Materials and methods: We performed a retrospective analysis of 82 patients with CDDW who received treatment from February 2004 to April 2019. We compared short-term and long-term results of treatment of 15 patients with isolated CDDW after PPDR and 42 patients with CDDW after pancreatoduodenectomy.

Results: The preoperative diagnosis was correct in 81 of the cases (98.8%). The patients experienced abdominal pain (100%), weight loss (76%), vomiting (30%), and jaundice (18%). CT, MRI, and endoUS were the most useful diagnostic modalities. Twelve patients with CDDW took conservative treatment due to rejection of the operation. The other patients underwent cystoenterostomies (8), duodenum-preserving pancreatic head (DPPH) resections (6), pancreatoduodenectomy (42) and PPDR (15) with zero mortality. Full pain control was achieved after PPDR in 93%, after pancreatoduodenectomy in 83%, and after draining procedures in 18% of the cases. Newly onset diabetes mellitus (7) and severe exocrine insufficiency (5) were common after pancreatoduodenectomy and never occurred after DPPH resections and PPDR. Weight gain was significantly higher after pancreatoduodenectomy and PPDR, compared to other treatment modalities.

Conclusion: PPDR is the optimal surgical procedure for the isolated form of CDDW. Early detection of CDDW allows for preservation of the pancreas. The pure form of groove pancreatitis is a disease of the duodenum, and the Whipple procedure should be considered excessive for this disease.

About the authors

V. I. Egorov

Il'inskaya Hospital

Email: egorov12333@gmail.com
ORCID iD: 0000-0002-8805-7604

Vyacheslav I. Egorov – MD, PhD, Head of Oncology Service

2–2 Rublevskoe predmest'e ul., Glukhovo, Krasnogorsk, Moscow Region, 143421

Russian Federation

R. V. Petrov

Bakhrushin Brothers Moscow City Hospital

Email: petrov-r-v@yandex.ru
ORCID iD: 0000-0003-3872-7363

Roman V. Petrov – MD, PhD, Surgeon, Oncologist

7 Stromynka ul., Moscow, 107014

Russian Federation

A. I. Schegolev

Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology

Email: ashegolev@oparina4.ru
ORCID iD: 0000-0002-2111-1530

Alexandr I. Shchyogolev– MD, PhD, Professor, Head of Department of Morbid Anatomy

4 Akademika Oparina ul., Moscow, 117997

Russian Federation

E. A. Dubova

State Research Center – Burnasyan Federal Medical Biophysical Center

Author for correspondence.
Email: fake@neicon.ru

Elena A. Dubova – MD, PhD, Pathologist, Department of Morbid Anatomy

46 Zhivopisnaya ul., Moscow, 123182

Russian Federation

A. N. Vankovich

Moscow Clinical Scientific Center

Email: a.vankovich@mknc.ru

Andrey N. Vankovich – MD, PhD, Surgeon, Department of Hepatic and Pancreas Surgery

86 Shosse Entuziastov, Moscow, 111123

Russian Federation

A. V. Dobriakov

Bakhrushin Brothers Moscow City Hospital

Email: a.w.dobryakov@mail.ru
ORCID iD: 0000-0002-1773-2916

Andrey V. Dobriakov – MD, PhD, Head of Department of Morbid Anatomy

7 Stromynka ul., Moscow, 107014

Russian Federation

N. A. Schvetz

Bakhrushin Brothers Moscow City Hospital

Email: shvetsnatsan67@mail.ru

Natalia A. Schvetz – MD, PhD, Pathologist, Department of Morbid Anatomy

7 Stromynka ul., Moscow, 107014

Russian Federation

E. A. Poputchikova

Bakhrushin Brothers Moscow City Hospital

Email: poputchikova.elena@yandex.ru

Elena A. Poputchikova – MD, PhD, Pathologist, Department of Morbid Anatomy

7 Stromynka ul., Moscow, 107014

Russian Federation

References

  1. Potet F, Duclert N. Cystic dystrophy on aberrant pancreas of the duodenal wall. Arch Fr Mal App Dig. 1970;59(4): 223–38. French.
  2. Flejou JF, Potet F, Molas G, Bernades P, Amouyal P, Fekete F. Cystic dystrophy of the gastric and duodenal wall developing in heterotopic pancreas: an unrecognised entity. Gut;34(3): 343–7. doi: 10.1136/gut.34.3.343.
  3. Vullierme MP, Vilgrain V, Flejou JF, Zins M, O'Toole D, Ruszniewski P, Belghiti J, Menu Y. Cystic dystrophy of the duodenal wall in the heterotopic pancreas: radiopathological correlations. J Comput Assist Tomogr. 2000;24(4): 635–43. doi: 10.1097/00004728-20000700000023.
  4. Jouannaud V, Coutarel P, Tossou H, Butel J, Vitte RL, Skinazi F, Blazquez M, Hagege H, Bories C, Rocher P, Belloula D, Latrive JP, Meurisse JJ, Eugene C, Dellion MP, Cadranel JF, Pariente A; Association Nationale des Hepato-Gastroenterologues des Hopitaux generaux. Cystic dystrophy of the duodenal wall associated with chronic alcoholic pancreatitis. Clinical features, diagnostic procedures and therapeutic management in a retrospective multicenter series of 23 patients. Gastroenterol Clin Biol. 2006;30(4): 580–6. doi: GCB04-2006-30-4-0399-8320-101019-200517810.
  5. Rebours V, Levy P, Vullierme MP, Couvelard A, O'Toole D, Aubert A, Palazzo L, Sauvanet A, Hammel P, Maire F, Ponsot P, Ruszniewski P. Clinical and morphological features of duodenal cystic dystrophy in heterotopic pancreas. Am J Gastroenterol. 2007;102(4): 871–9. doi: 10.1111/j.1572-0241.2007.01091.x.
  6. Egorov VI, Vankovich AN, Petrov RV, Starostina NS, Butkevich ATs, Sazhin AV, Stepanova EA. Pancreas-preserving approach to "paraduodenal pancreatitis" treatment: why, when, and how? Experience of treatment of 62 patients with duodenal dystrophy. Biomed Res Int. 2014;2014:185265. doi: 10.1155/2014/185265.
  7. Pezzilli R, Santini D, Calculli L, Casadei R, MorselliLabate AM, Imbrogno A, Fabbri D, Taffurelli G, Ricci C, Corinaldesi R. Cystic dystrophy of the duodenal wall is not always associated with chronic pancreatitis. World J Gastroenterol. 2011;17(39): 4349–64. doi: 10.3748/wjg.v17.i39.4349.
  8. Stolte M, Weiss W, Volkholz H, Rosch W. A special form of segmental pancreatitis: "groove pancreatitis". Hepatogastroenterology. 1982;29(5): 198–208.
  9. Becker V, Mischke U. Groove pancreatitis. Int J Pancreatol. 1991;10(3–4): 173–82.
  10. Lohr JM, Dominguez-Munoz E, Rosendahl J, Besselink M, Mayerle J, Lerch MM, Haas S, Akisik F, Kartalis N, Iglesias-Garcia J, Keller J, Boermeester M, Werner J, Dumonceau JM, Fockens P, Drewes A, Ceyhan G, Lindkvist B, Drenth J, Ewald N, Hardt P, de Madaria E, Witt H, Schneider A, Manfredi R, Brondum FJ, Rudolf S, Bollen T, Bruno M; HaPanEU/UEG Working Group. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J. 2017;5(2): 153–99. doi: 10.1177/2050640616684695.
  11. Issa Y, van Santvoort HC, Fockens P, Besselink MG, Bollen TL, Bruno MJ, Boermeester MA; Collaborators. Diagnosis and treatment in chronic pancreatitis: an international survey and case vignette study. HPB (Oxford). 2017;19(11): 978–85. doi: 10.1016/j.hpb.2017.07.006.
  12. Suda K, Takase M, Shiono S, Yamasaki S, Nobukawa B, Kasamaki S, Arakawa A, Suzuki F. Duodenal wall cysts may be derived from a ductal component of ectopic pancreatic tissue. Histopathology. 2002;41(4): 351–6. doi: 10.1046/j.1365-2559.2002.01453.x.
  13. Bill K, Belber JP, Carson JW. Adenomyoma (pancreatic heterotopia) of the duodenum producing common bile duct obstruction. Gastrointest Endosc. 1982;28(3): 182–4. doi: 10.1016/s0016-5107(82)73049-4.
  14. Aoun N, Zafatayeff S, Smayra T, Haddad-Zebouni S, Tohme C, Ghossain M. Adenomyoma of the ampullary region: imaging findings in four patients. Abdom Imaging. 2005;30(1): 86–9. doi: 10.1007/s00261-004-0224-1.
  15. Adsay NV, Zamboni G. Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying "cystic dystrophy of heterotopic pancreas", "para-duodenal wall cyst", and "groove pancreatitis". Semin Diagn Pathol. 2004;21(4): 247–54. doi: 10.1053/j.semdp.2005.07.005.
  16. Casetti L, Bassi C, Salvia R, Butturini G, Graziani R, Falconi M, Frulloni L, Crippa S, Zamboni G, Pederzoli P. "Paraduodenal" pancreatitis: results of surgery on 58 consecutives patients from a single institution. World J Surg. 2009;33(12): 2664–9. doi: 10.1007/s00268-0090238-5.
  17. de Pretis N, Capuano F, Amodio A, Pellicciari M, Casetti L, Manfredi R, Zamboni G, Capelli P, Negrelli R, Campagnola P, Fuini A, Gabbrielli A, Bassi C, Frulloni L. Clinical and Morphological Features of Paraduodenal Pancreatitis: An Italian Experience With 120 Patients. Pancreas. 2017;46(4): 489–95. doi: 10.1097/MPA.0000000000000781.
  18. Izbicki JR, Knoefel WT, Muller-Hocker J, Mandelkow HK. Pancreatic hamartoma: a benign tumor of the pancreas. Am J Gastroenterol. 1994;89(8): 1261–2.
  19. Wu SS, Vargas HI, French SW. Pancreatic hamartoma with Langerhans cell histiocytosis in a draining lymph node. Histopathology. 1998;33(5): 485–7. doi: 10.1046/j.13652559.1998.0491c.x.
  20. McFaul CD, Vitone LJ, Campbell F, Azadeh B, Hughes ML, Garvey CJ, Ghaneh P, Neoptolemos JP. Pancreatic hamartoma. Pancreatology. 2004;4(6): 533–7; discussion 537–8.
  21. Rubay R, Bonnet D, Gohy P, Laka A, Deltour D. Cystic dystrophy in heterotopic pancreas of the duodenal wall: medical and surgical treatment. Acta Chir Belg. 1999;99(2): 87–91.
  22. Bittar I, Cohen Solal JL, Cabanis P, Hagege H. Cystic dystrophy of an aberrant pancreas. Surgery after failure of medical therapy. Presse Med. 2000;29(20): 1118–20. French.
  23. Basili E, Allemand I, Ville E, Laugier R. Lanreotide acetate may cure cystic dystrophy in heterotopic pancreas of the duodenal wall. Gastroenterol Clin Biol. 2001;25(12): 1108–11. French. doi: GCB-12-2001-25-12-0399-8320101019-ART10.
  24. Egorov VI, Butkevich AC, Sazhin AV, Yashina NI, Bogdanov SN. Pancreas-preserving duodenal resections with bile and pancreatic duct replantation for duodenal dystrophy. Two case reports. JOP. 2010;11(5): 446–52.
  25. Gloor B, Friess H, Uhl W, Buchler MW. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig Surg. 2001;18(1): 21–5. doi: 10.1159/000050092.
  26. Frey CF, Mayer KL. Comparison of local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (frey procedure) and duodenum-preserving resection of the pancreatic head (beger procedure). World J Surg. 2003;27(11): 1217–30. doi: 10.1007/s00268-003-7241-z.
  27. Nakao A. Pancreatic head resection with segmental duodenectomy and preservation of the gastroduodenal artery. Hepatogastroenterology. 1998;45(20): 533–5.
  28. Yu J, Fulcher AS, Turner MA, Halvorsen RA. Normal anatomy and disease processes of the pancreatoduodenal groove: imaging features. AJR Am J Roentgenol. 2004;183(3): 839–46. doi: 10.2214/ajr.183.3.1830839.
  29. Graziani R, Tapparelli M, Malago R, Girardi V, Frulloni L, Cavallini G, Pozzi Mucelli R. The various imaging aspects of chronic pancreatitis. JOP. 2005;6(1 Suppl):73–88.
  30. Catalano MF, Sahai A, Levy M, Romagnuolo J, Wiersema M, Brugge W, Freeman M, Yamao K, Canto M, Hernandez LV. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. 2009;69(7): 1251–61. doi: 10.1016/j.gie.2008.07.043.
  31. Stevens T, Lopez R, Adler DG, Al-Haddad MA, Conway J, Dewitt JM, Forsmark CE, Kahaleh M, Lee LS, Levy MJ, Mishra G, Piraka CR, Papachristou GI, Shah RJ, Topazian MD, Vargo JJ, Vela SA. Multicenter comparison of the interobserver agreement of standard EUS scoring and Rosemont classification scoring for diagnosis of chronic pancreatitis. Gastrointest Endosc. 2010;71(3): 519–26. doi: 10.1016/j.gie.2009.10.043.
  32. Kalmin B, Hoffman B, Hawes R, Romagnuolo J. Conventional versus Rosemont endoscopic ultrasound criteria for chronic pancreatitis: comparing interobserver reliability and intertest agreement. Can J Gastroenterol. 2011;25(5): 261–4. doi: 10.1155/2011/302382.
  33. Fukino N, Oida T, Mimatsu K, Kuboi Y, Kida K. Adenocarcinoma arising from heterotopic pancreas at the third portion of the duodenum. World J Gastroenterol. 2015;21(13): 4082–8. doi: 10.3748/wjg.v21.i13.4082.
  34. Betzler A, Mees ST, Pump J, Scholch S, Zimmermann C, Aust DE, Weitz J, Welsch T, Distler M. Clinical impact of duodenal pancreatic heterotopia – Is there a need for surgical treatment? BMC Surg. 2017;17(1): 53. doi: 10.1186/s12893017-0250-x.
  35. Tison C, Regenet N, Meurette G, Mirallie E, Cassagnau E, Frampas E, Le Borgne J. Cystic dystrophy of the duodenal wall developing in heterotopic pancreas: report of 9 cases. Pancreas. 2007;34(1): 152–6. doi: 10.1097/01.mpa.0000246669.61246.08.
  36. Chung RS, Church JM, vanStolk R. Pancreassparing duodenectomy: indications, surgical technique, and results. Surgery. 1995;117(3): 254–9. doi: 10.1016/s0039-6060(05)80198-9.
  37. Bloechle C, Izbicki JR, Knoefel WT, Kuechler T, Broelsch CE. Quality of life in chronic pancreatitis – results after duodenum-preserving resection of the head of the pancreas. Pancreas. 1995;11(1): 77–85. doi: 10.1097/00006676199507000-00008.
  38. Oza VM, Skeans JM, Muscarella P, Walker JP, Sklaw BC, Cronley KM, El-Dika S, Swanson B, Hinton A, Conwell DL, Krishna SG. Groove Pancreatitis, a Masquerading Yet Distinct Clinicopathological Entity: Analysis of Risk Factors and Differentiation. Pancreas. 2015;44(6): 901– 8. doi: 10.1097/MPA.0000000000000351.
  39. Odgers PN. Some Observations on the Development of the Ventral Pancreas in Man. J Anat. 1930;65(Pt 1): 1–7.
  40. Hagai H. Configurational anatomy of the pancreas: its surgical relevance from ontogenetic and comparative-anatomical viewpoints. J Hepatobiliary Pancreat Surg. 2003;10(1): 48–56. doi: 10.1007/s10534-002-0796-6.
  41. Wagner M, Vullierme MP, Rebours V, Ronot M, Ruszniewski P, Vilgrain V. Cystic form of paraduodenal pancreatitis (cystic dystrophy in heterotopic pancreas (CDHP)): a potential link with minor papilla abnormalities? A study in a large series. Eur Radiol. 2016;26(1): 199–205. doi: 10.1007/s00330-015-3799-8.
  42. Arora A, Rajesh S, Mukund A, Patidar Y, Thapar S, Arora A, Bhatia V. Clinicoradiological appraisal of 'paraduodenal pancreatitis': Pancreatitis outside the pancreas! Indian J Radiol Imaging. 2015;25(3): 303–14. doi: 10.4103/0971-3026.161467.
  43. Kager LM, Lekkerkerker SJ, Arvanitakis M, Delhaye M, Fockens P, Boermeester MA, van Hooft JE, Besselink MG. Outcomes After Conservative, Endoscopic, and Surgical Treatment of Groove Pancreatitis: A Systematic Review. J Clin Gastroenterol. 2017;51(8): 749–54. doi: 10.1097/MCG.0000000000000746.
  44. de Parades V, Roulot D, Palazzo L, Chaussade S, Mingaud P, Rautureau J, Coste T. Treatment with octreotide of stenosing cystic dystrophy on heterotopic pancreas of the duodenal wall. Gastroenterol Clin Biol. 1996;20(6–7): 601–4. French.
  45. Raman SP, Salaria SN, Hruban RH, Fishman EK. Groove pancreatitis: spectrum of imaging findings and radiology-pathology correlation. AJR Am J Roentgenol. 2013;201(1):W29–39. doi: 10.2214/AJR.12.9956.
  46. Kim JD, Han YS, Choi DL. Characteristic clinical and pathologic features for preoperative diagnosed groove pancreatitis. J Korean Surg Soc. 2011;80(5): 342–7. doi: 10.4174/jkss.2011.80.5.342.
  47. Goldaracena N, McCormack L. A typical feature of groove pancreatitis. HPB (Oxford). 2012;14(7): 487–8. doi: 10.1111/j.14772574.2012.00469.x.

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Copyright (c) 2019 Egorov V.I., Petrov R.V., Schegolev A.I., Dubova E.A., Vankovich A.N., Dobriakov A.V., Schvetz N.A., Poputchikova E.A.

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