Simple pancreatoduodenectomy – simplified technique of pancreatoduodenectomy for benign and early malignant lesions of the ampullary region – case series

Introduction and importance: Pancreatoduodenectomy (PD) is the standard surgery performed for patients with malignant and benign diseases of the periampullary region. PD involves resection of not only the tissues in and around the ampulla but also a few vital organs, such the first part of the duodenum (D1), the first part of the jejunum, and the gallbladder (GB). Historically, these surrounding vital structures were resected for technical feasibility rather than for oncological outcomes in patients with periampullary tumors. Case presentation: We performed this modification of PD in 11 patients with periampullary tumors, and the outcomes were analyzed retrospectively. Technically, it was feasible in all patients, where we could preserve GB, D1, and the first part of jejunum. There was no 90-day mortality, and the overall morbidity was 36%. A tumor-free margin was achieved in all patients, and patients with malignant disease received adjuvant therapy within 4 weeks of surgery. Clinical discussion: This simplified technique of PD, performed only on the right side of the portal vein axis without removing extra structures like the stomach, D1, D4 of the duodenum, GB, and jejunum, avoids dissection in non-essential areas, reduces operative time and blood loss, and can help the patient recover quickly. Conclusion: A simple modification of PD, wherein preserving the vital structures like the GB, duodenum, and the first part of the jejunum, is safe and feasible in patients with benign and malignant diseases of the periampullary region. This technique showed oncological safety with low morbidity but requires large prospective studies to further establish its role in the management of these tumors.