Surgical key points and applications of duodenum, common bile duct and Oddi’s sphincter-preserving pancreatic head total resection (DCOPPHTR, Wang’s procedure)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Yongjun , XIANG Jifeng ,  WANG Huaizhi

Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing 401147, P. R. China;

Corresponding?author：

WANG Huaizhi, Email: whuaizhi@gmail.com

Keywords：

chronic pancreatitis; duodenum preservation; total en bloc pancreatic head resection; Oddi sphincter; benign pancreatic head tumor

DOI：

10.7507/1007-9424.202409008

Video：

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The surgical treatment of chronic pancreatitis, benign, borderline and low-grade malignant tumors of the pancreatic head is definite in effect. How to preserve more functional organs is the focus of such surgeries. The duodenum, common bile duct and Oddi’s sphincter-preserving pancreatic head total resection (DCOPPHTR) surgical method pioneered by the author team has theoretical advantages compared to other surgical methods. However, due to the difficulty of surgical operation and higher requirements for surgeons, its widespread application is limited. By elaborating on the invention principle and evolution process of this surgery, analyzing the key steps in detail and showing the clinical effects, the author proves that DCOPPHTR is safe and effective and has higher clinical application value.

Citation： YANG Yongjun, XIANG Jifeng, WANG Huaizhi. Surgical key points and applications of duodenum, common bile duct and Oddi’s sphincter-preserving pancreatic head total resection (DCOPPHTR, Wang’s procedure). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(2): 143-147. doi: 10.7507/1007-9424.202409008 Copy

1.	中國醫師協會胰腺病專業委員會慢性胰腺炎專委會. 慢性胰腺炎診治指南 (2018, 廣州). 臨床肝膽病雜志, 2019, 35(1): 45-51.
2.	Paluri RK, John TA, Anastasopoulou C, et al. Solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas. 2024 Jan 10. In: StatPearls [Internet]. Treasre Island (FL): StatPearls Publishing, 2024.
3.	Cai QY, Tan K, Zhang XL, et al. Incidence, prevalence, and comorbidities of chronic pancreatitis: a 7-year population-based study. World J Gastroenterol, 2023, 29(30): 4671-4684.
4.	Beger HG, Rau BM, Gansauge F, et al. Duodenum-preserving total pancreatic head resection for cystic neoplasm: a limited but cancer-preventive procedure. Langenbecks Arch Surg, 2008, 393(4): 589-598.
5.	Justo Alonso I, Marcacuzco Quinto A, Caso Maestro O, et al. Whipple’s cephalic pancreaticoduodenectomy versus pyloric-preserving pancreaticoduodenectomy. Retrospective study. Cir Esp (Engl Ed), 2024, 102(5): 265-274.
6.	Beger HG, Friess H, Uhl W. Whipple resection for benign tumors and premalignant neoplasms of the pancreatic head: surgery-associated risk for complications and late metabolic morbidity matters. Ann Surg Open, 2023, 4(3): e325. doi: 10.1097/AS9.0000000000000325.
7.	Beger HG, Krautzberger W, Bittner R, et al. Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery, 1985, 97(4): 467-473.
8.	Diener MK, Rahbari NN, Fischer L, et al. Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis. Ann Surg, 2008, 247(6): 950-961.
9.	Zheng Z, Xiang G, Tan C, et al. Pancreaticoduodenectomy versus duodenum-preserving pancreatic head resection for the treatment of chronic pancreatitis. Pancreas, 2012, 41(1): 147-152.
10.	Zu G, Chen W, Wu D, et al. Clinical outcomes of minimally invasive duodenum-preserving pancreatic head resection. BMC Surg, 2023, 23(1): 288. doi: 10.1186/s12893-023-02170-9.
11.	劉頌, 盧杏生. 保留十二指腸的胰頭切除術的臨床及微創應用進展. 中國普外基礎與臨床雜志, 2023, 30(11): 1395-1401.
12.	Wang HZ, Yang JH, Xie B. Duodenum preserving total pancreatic head resection for pancreatolithiasis of pancreatic head. Pancreatology, 2013, 13(4 Suppl): S9.
13.	Lu C, Xu B, Mou Y, et al. Laparoscopic duodenum-preserving pancreatic head resection with real-time indocyanine green guidance of different dosage and timing: enhanced safety with visualized biliary duct and its long-term metabolic morbidity. Langenbecks Arch Surg, 2022, 407(7): 2823-2832.
14.	Chen S, Gao P, Cai H, et al. Indocyanine green-enhanced fluorescence in laparoscopic duodenum-preserving pancreatic head resection: technique with video. Ann Surg Oncol, 2020, 27(10): 3926-3927.
15.	譚明達, 顏軍, 郭詩翔. 保留十二指腸、膽總管、Oddi括約肌的胰頭整塊全切除術后并發癥分析. 中華肝臟外科手術學電子雜志, 2024, 13(2): 145-150.
16.	Beger HG, Mayer B, Rau BM. Parenchyma-sparing, limited pancreatic head resection for benign tumors and low-risk periampullary cancer-a systematic review. J Gastrointest Surg, 2016, 20(1): 206-217.
17.	Beger HG, Mayer B, Poch B. Parenchyma-sparing, local pancreatic head resection for premalignant and low-malignant neoplasms - a systematic review and meta-analysis. Am J Surg, 2018, 216(6): 1182-1191.
18.	楊永君, 郭詩翔, 王槐志. 胰腺癌多學科綜合治療體會與思考. 腹部外科, 2022, 35(5): 305-308.
19.	賀卓, 王進峰, 羅建紅, 等. 胰十二指腸切除術150例圍手術期并發癥臨床分析. 中國普通外科雜志, 2021, 30(3): 357-364.
20.	Pedrazzoli S. Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF): a systematic review and analysis of the POPF-related mortality rate in 60, 739 patients retrieved from the English literature published between 1990 and 2015. Medicine (Baltimore), 2017, 96(19): e6858. doi: 10.1097/MD.0000000000006858.
21.	孫浦, 徐寅凱, 何駿, 等. 保留十二指腸胰頭全切除術11例臨床分析. 肝膽胰外科雜志, 2024, 36(2): 75-80.
22.	Bachmann K, Tomkoetter L, Kutup A, et al. Is the Whipple procedure harmful for long-term outcome in treatment of chronic pancreatitis? 15-years follow-up comparing the outcome after pylorus-preserving pancreatoduodenectomy and Frey procedure in chronic pancreatitis. Ann Surg, 2013, 258(5): 815-820, 820-821.
23.	Yin T, Wen J, Zhen T, et al. Long-term quality of life between duodenum-preserving pancreatic head resection and pancreatoduodenectomy: a systematic review and meta-analysis. Int J Surg, 2024, 110(2): 1139-1148.
24.	Zhao X, Cui N, Wang X, et al. Surgical strategies in the treatment of chronic pancreatitis: an updated systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2017, 96(9): e6220. doi: 10.1097/MD.0000000000006220.
25.	Jiang Y, Jin JB, Zhan Q, et al. Robot-assisted duodenum-preserving pancreatic head resection with pancreaticogastrostomy for benign or premalignant pancreatic head lesions: a single-centre experience. Int J Med Robot, 2018, 14(4): e1903. doi: 10.1002/rcs.1903.
26.	陳智猛, 孫瑞, 賴魁元, 等. 腹腔鏡保留十二指腸胰頭切除術單中心初步經驗: 附10例報告. 中國普通外科雜志, 2024, 33(3): 448-455.

1. 中國醫師協會胰腺病專業委員會慢性胰腺炎專委會. 慢性胰腺炎診治指南 (2018, 廣州). 臨床肝膽病雜志, 2019, 35(1): 45-51.
2. Paluri RK, John TA, Anastasopoulou C, et al. Solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas. 2024 Jan 10. In: StatPearls [Internet]. Treasre Island (FL): StatPearls Publishing, 2024.
3. Cai QY, Tan K, Zhang XL, et al. Incidence, prevalence, and comorbidities of chronic pancreatitis: a 7-year population-based study. World J Gastroenterol, 2023, 29(30): 4671-4684.
4. Beger HG, Rau BM, Gansauge F, et al. Duodenum-preserving total pancreatic head resection for cystic neoplasm: a limited but cancer-preventive procedure. Langenbecks Arch Surg, 2008, 393(4): 589-598.
5. Justo Alonso I, Marcacuzco Quinto A, Caso Maestro O, et al. Whipple’s cephalic pancreaticoduodenectomy versus pyloric-preserving pancreaticoduodenectomy. Retrospective study. Cir Esp (Engl Ed), 2024, 102(5): 265-274.
6. Beger HG, Friess H, Uhl W. Whipple resection for benign tumors and premalignant neoplasms of the pancreatic head: surgery-associated risk for complications and late metabolic morbidity matters. Ann Surg Open, 2023, 4(3): e325. doi: 10.1097/AS9.0000000000000325.
7. Beger HG, Krautzberger W, Bittner R, et al. Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis. Surgery, 1985, 97(4): 467-473.
8. Diener MK, Rahbari NN, Fischer L, et al. Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis. Ann Surg, 2008, 247(6): 950-961.
9. Zheng Z, Xiang G, Tan C, et al. Pancreaticoduodenectomy versus duodenum-preserving pancreatic head resection for the treatment of chronic pancreatitis. Pancreas, 2012, 41(1): 147-152.
10. Zu G, Chen W, Wu D, et al. Clinical outcomes of minimally invasive duodenum-preserving pancreatic head resection. BMC Surg, 2023, 23(1): 288. doi: 10.1186/s12893-023-02170-9.
11. 劉頌, 盧杏生. 保留十二指腸的胰頭切除術的臨床及微創應用進展. 中國普外基礎與臨床雜志, 2023, 30(11): 1395-1401.
12. Wang HZ, Yang JH, Xie B. Duodenum preserving total pancreatic head resection for pancreatolithiasis of pancreatic head. Pancreatology, 2013, 13(4 Suppl): S9.
13. Lu C, Xu B, Mou Y, et al. Laparoscopic duodenum-preserving pancreatic head resection with real-time indocyanine green guidance of different dosage and timing: enhanced safety with visualized biliary duct and its long-term metabolic morbidity. Langenbecks Arch Surg, 2022, 407(7): 2823-2832.
14. Chen S, Gao P, Cai H, et al. Indocyanine green-enhanced fluorescence in laparoscopic duodenum-preserving pancreatic head resection: technique with video. Ann Surg Oncol, 2020, 27(10): 3926-3927.
15. 譚明達, 顏軍, 郭詩翔. 保留十二指腸、膽總管、Oddi括約肌的胰頭整塊全切除術后并發癥分析. 中華肝臟外科手術學電子雜志, 2024, 13(2): 145-150.
16. Beger HG, Mayer B, Rau BM. Parenchyma-sparing, limited pancreatic head resection for benign tumors and low-risk periampullary cancer-a systematic review. J Gastrointest Surg, 2016, 20(1): 206-217.
17. Beger HG, Mayer B, Poch B. Parenchyma-sparing, local pancreatic head resection for premalignant and low-malignant neoplasms - a systematic review and meta-analysis. Am J Surg, 2018, 216(6): 1182-1191.
18. 楊永君, 郭詩翔, 王槐志. 胰腺癌多學科綜合治療體會與思考. 腹部外科, 2022, 35(5): 305-308.
19. 賀卓, 王進峰, 羅建紅, 等. 胰十二指腸切除術150例圍手術期并發癥臨床分析. 中國普通外科雜志, 2021, 30(3): 357-364.
20. Pedrazzoli S. Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF): a systematic review and analysis of the POPF-related mortality rate in 60, 739 patients retrieved from the English literature published between 1990 and 2015. Medicine (Baltimore), 2017, 96(19): e6858. doi: 10.1097/MD.0000000000006858.
21. 孫浦, 徐寅凱, 何駿, 等. 保留十二指腸胰頭全切除術11例臨床分析. 肝膽胰外科雜志, 2024, 36(2): 75-80.
22. Bachmann K, Tomkoetter L, Kutup A, et al. Is the Whipple procedure harmful for long-term outcome in treatment of chronic pancreatitis? 15-years follow-up comparing the outcome after pylorus-preserving pancreatoduodenectomy and Frey procedure in chronic pancreatitis. Ann Surg, 2013, 258(5): 815-820, 820-821.
23. Yin T, Wen J, Zhen T, et al. Long-term quality of life between duodenum-preserving pancreatic head resection and pancreatoduodenectomy: a systematic review and meta-analysis. Int J Surg, 2024, 110(2): 1139-1148.
24. Zhao X, Cui N, Wang X, et al. Surgical strategies in the treatment of chronic pancreatitis: an updated systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2017, 96(9): e6220. doi: 10.1097/MD.0000000000006220.
25. Jiang Y, Jin JB, Zhan Q, et al. Robot-assisted duodenum-preserving pancreatic head resection with pancreaticogastrostomy for benign or premalignant pancreatic head lesions: a single-centre experience. Int J Med Robot, 2018, 14(4): e1903. doi: 10.1002/rcs.1903.
26. 陳智猛, 孫瑞, 賴魁元, 等. 腹腔鏡保留十二指腸胰頭切除術單中心初步經驗: 附10例報告. 中國普通外科雜志, 2024, 33(3): 448-455.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Surgical key points and applications of duodenum, common bile duct and Oddi’s sphincter-preserving pancreatic head total resection (DCOPPHTR, Wang’s procedure)

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