Clinical Application of Beger Procedure and Frey Procedure for Benign Disease or Low-Grade Malignant Potential Lesion of Pancreas_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Yonghua , DU Bingqing , XIANG Guangming , ZHENG Zhenjiang , LIU Xubao , MAI Gang.

Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

Keywords：

Duodenum-preserving pancreatic head resection; Pancreatic cystic neoplasm; Chronic pancreatitis

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ObjectiveTo review the current clinical application of Beger procedure and Frey procedure for benign disease or low-grade malignant potential lesion of pancreas. MethodsRelevant literatures about current advance of clinical application of Beger procedure and Frey procedure published recently of domestic and abroad were collected and reviewed. ResultsWith the concept of organ-preserving operations was adopted in recent years, Beger procedure and Frey procedure were applied generally. Beger procedure and Frey procedure were associated with tolerable perioperative risk, postoperative complications, and good outcomes in the aspects of preservation of function and curability in these lesions compared to conventional pancreatectomy, with preservation of the physiological food passage, thus patients gained weight faster, had less pain, and demonstrated better exocrine and endocrine pancreatic function postoperatively and an improvement in the quality of life. Both procedures had reached an international position as a standard operation for the treatment of benign disease or low-grade malignant potential lesion of pancreas. But after long-term following-up early advantages were no longer present. ConclusionsBeger procedure and Frey procedure are safe and effective in providing good outcomes in the aspects of preservation of function and curability in benign disease or low-grade malignant potential lesion of pancreas. Organ-preserving pancreatectomy could become a new organ-preserving standard operation.

Citation： CHEN Yonghua,DU Bingqing,XIANG Guangming,ZHENG Zhenjiang,LIU Xubao,MAI Gang.. Clinical Application of Beger Procedure and Frey Procedure for Benign Disease or Low-Grade Malignant Potential Lesion of Pancreas. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(3): 341-347. doi: Copy

1.	Beger HG, Witte C, Krautzberger W, et al. Experiences with duodenumsparing pancreas head resection in chronic pancreatitis [J]. Chirurg, 1980, 51(5): 303307.
2.	Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis [J]. Pancreas, 1987, 2(6): 701707.
3.	Müller MW, Friess H, Leitzbach S, et al. Perioperative and followup results after central pancreatic head resection (Berne technique) in a consecutive series of patients with chronic pancreatitis [J]. Am J Surg, 2008, 196(3): 364372.
4.	Strobel O, Büchler MW, Werner J. Surgical therapy of chronic pancreatitis: indications, techniques and results [J]. Int J Surg, 2009, 7(4): 305312.
5.	Varghese TK, Bell RH Jr. Duodenumpreserving head resection for chronic pancreatitis: an institutional experience and national survey of usage [J]. Surgery, 2007, 142(4): 588593.
6.	Lee SE, Jang JY, Hwang DW, et al. Clinical efficacy of organpreserving pancreatectomy for benign or lowgrade malignant potential lesion [J]. J Korean Med Sci, 2010, 25(1): 97103.
7.	Bell RH Jr. Atlas of pancreatic surgery//Bell RH Jr, Rikkers LF, Mulholland MW. Digestive trac surgery. A text and Atlas [M]. Philadelphia, PA: Lippincott Raven, 1996: 10141015.
8.	Horiguchi A, Miyakawa S, Ishihara S, et al. Surgical design and outcome of duodenumpreserving pancreatic head resection for benign or lowgrade malignant tumors [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 792797.
9.	刘续宝, 肖乾虎. 腹部外科手术要点及围手术期处理 [M]. 北京: 科学出版社， 2010: 436437.
10.	Kat’uchová J, Bober J, Závacky P. Chronic pancreatitis, indications for resection procedures and postoperative complications [J]. Rozhl Chir, 2008, 87(4): 200206.
11.	Chirletti P, Peparini N, Caronna R, et al. RouxenY endtoend and endtoside double pancreaticojejunostomy: application of the reconstructive method of the Beger procedure to central pancreatectomy [J]. Langenbecks Arch Surg, 2010, 395(1): 8993.
12.	Hatori T, Imaizumi T, Harada N, et al. Appraisal of the Imaizumi modification of the Beger procedure: the TWMU experience [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 752757.
13.	Cataldegirmen G, Bogoevski D, Mann O, et al. Late morbidity after duodenumpreserving pancreatic head resection with bile duct reinsertion into the resection cavity [J]. Br J Surg, 2008, 95(4): 447452.
14.	Beger HG, Schlosser W, Friess HM, et al. Duodenumpreserving head resection in chronic pancreatitis changes the natural course of the disease: a singlecenter 26year experience [J]. Ann Surg, 1999, 230(4): 512519.
15.	Mihaljevic AL, Kleeff J, Friess H. Beger’s operation and the Berne modification: origin and current results [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 735744.
16.	Gloor B, Friess H, Uhl W, et al. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis [J]. Dig Surg, 2001, 18(1): 2125.
17.	Aspelund G, Topazian MD, Lee JH, et al. Improved outcomes for benign disease with limited pancreatic head resection [J]. J Gastrointest Surg, 2005, 9(3): 400409.
18.	Farkas G, Leindler L, Daróczi M, et al. Prospective randomised comparison of organpreserving pancreatic head resection with pyloruspreserving pancreaticoduodenectomy [J]. Langenbecks Arch Surg, 2006, 391(4): 338342.
19.	Riediger H, Adam U, Fischer E, et al. Longterm outcome after resection for chronic pancreatitis in 224 patients [J]. J Gastrointest Surg, 2007, 11(8): 949959.
20.	Diener MK, Bruckner T, Contin P, et al. ChroPactrial: duodenumpreserving pancreatic head resection versus pancreatoduodenectomy for chronic pancreatitis. Trial protocol of a randomised controlled multicentre trial [J]. Trials, 2010, 11: 47.
21.	Busquets J, Fabregat J, Borobia FG, et al. Organpreserving surgery for benign lesions and lowgrade malignancies of the pancreatic head: a matched casecontrol study [J]. Surg Today, 2010, 40(2): 125131.
22.	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) [J]. World J Surg, 2003, 27(11): 12171230.
23.	郑振江, 刘续宝, 麦刚, 等. 胰十二指肠切除术和保留十二指肠的胰头切除术治疗慢性胰腺炎的临床疗效比较 [J]. 四川大学学报（医学版） , 2008, 39(4): 686687.
24.	Egawa S, Motoi F, Sakata N, et al. Assessment of Frey procedures: Japanese experience [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 745751.
25.	Schneider CG, Cataldegirmen G, Mann O, et al. Lateral anastomosis techniques: PartingtonRochelle and Vshaped excision [J]. Chirurg, 2009, 80(1): 2833.
26.	Strobel O, Büchler MW, Werner J. Duodenumpreserving pancreatic head resection: technique according to Beger, technique according to Frey and Berne modifications [J]. Chirurg, 2009, 80(1): 2227.
27.	Andersen DK, Frey CF. The evolution of the surgical treatment of chronic pancreatitis [J]. Ann Surg, 2010, 251(1): 1832.
28.	Ebbehj N, Borly L, Bülow J, et al. Pancreatic tissue fluid pressure in chronic pancreatitis. Relation to pain, morphology, and function [J]. Scand J Gastroenterol, 1990, 25(10): 10461051.
29.	Di Sebastiano P, di Mola FF, Bockman DE, et al. Chronic pancreatitis: the perspective of pain generation by neuroimmune interaction [J]. Gut, 2003, 52(6): 907911.
30.	Zhu ZW, Friess H, Wang L, et al. Brainderived neurotrophic factor (BDNF) is upregulated and associated with pain in chronic pancreatitis [J]. Dig Dis Sci, 2001, 46(8): 16331639.
31.	Beger HG, Schlosser W, Poch B, et al. Inflammatory mass in the head of pancreas//Beger HG, Warshaw AL, Büchler MW， et al. The pancreas [M]. Oxford: Blackwell Science, 1998: 757760.
32.	Schlosser W, Siech M, Grich J, et al. Common bile duct stenosis in complicated chronic pancreatitis [J]. Scand J Gastroenterol, 2001, 36(2): 214219.
33.	Heider TR, Azeem S, Galanko JA, et al. The natural history of pancreatitisinduced splenic vein thrombosis [J]. Ann Surg, 2004, 239(6): 876880.
34.	Rieder S, Michalski CW, Friess H. Indications for endoscopic or surgical treatment of chronic pancreatitis [J]. Dig Dis, 2010, 28(2): 344349.
35.	Isaji S. Has the Partington procedure for chronic pancreatitis become a thing of the past? A review of the evidence [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 763769.
36.	Menge BA, Schrader H, Breuer TG, et al. Metabolic consequences of a 50% partial pancreatectomy in humans [J]. Diabetologia, 2009, 52(2): 306317.
37.	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 [J]. Ann Surg, 2008, 247(6): 950961.
38.	Mihaljevic AL, Kleeff J, Friess H, et al. Surgical approaches to chronic pancreatitis [J]. Best Pract Res Clin Gastroenterol, 2008, 22(1): 167181.
39.	Bachmann K, Kutup A, Mann O, et al. Surgical treatment in chronic pancreatitis timing and type of procedure [J]. Best Pract Res Clin Gastroenterol, 2010, 24(3): 299310.
40.	Müller MW, Friess H, Martin DJ, et al. Longterm followup of a randomized clinical trial comparing Beger with pyloruspreserving Whipple procedure for chronic pancreatitis [J]. Br J Surg, 2008, 95(3): 350356.
41.	McClaine RJ, Lowy AM, Matthews JB, et al. A comparison of pancreaticoduodenectomy and duodenumpreserving head resection for the treatment of chronic pancreatitis [J]. HPB (Oxford), 2009, 11(8): 677683.
42.	Strate T, Taherpour Z, Bloechle C, et al. Longterm followup of a randomized trial comparing the beger and frey procedures for patients suffering from chronic pancreatitis [J]. Ann Surg, 2005, 241(4): 591598.
43.	Malka D, Hammel P, Sauvanet A, et al. Risk factors for diabetes mellitus in chronic pancreatitis [J]. Gastroenterology, 2000, 119(5): 13241332.
44.	Izbicki JR, Bloechle C, Knoefel WT, et al. Duodenumpreserving resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized trial [J]. Ann Surg, 1995, 221(4): 350358.
45.	Keck T, Wellner UF, Riediger H, et al. Longterm outcome after 92 duodenumpreserving pancreatic head resections for chronic pancreatitis: comparison of Beger and Frey procedures [J]. J Gastrointest Surg, 2010, 14(3): 549556.
46.	Keck T, Marjanovic G, Fernandezdel Castillo C, et al. The inflammatory pancreatic head mass: significant differences in the anatomic pathology of German and American patients with chronic pancreatitis determine very different surgical strategies [J]. Ann Surg, 2009, 249(1): 105110.
47.	Amudhan A, Balachandar TG, Kannan DG, et al. Factors affecting outcome after Frey procedure for chronic pancreatitis [J]. HPB (Oxford), 2008, 10(6): 477482.
48.	刘续宝, 龚军. 慢性胰腺炎的手术治疗方式 [J]. 临床外科杂志， 2009, 17(6): 378380.
49.	Uguz A, Yakan S, Gurcu B, et al. Xanthogranulomatous pancreatitis treated by duodenumpreserving pancreatic head resection [J]. Hepatobiliary Pancreat Dis Int, 2010, 9(2): 216218.
50.	Beger HG, Rau BM. New advances in pancreatic surgery [J]. Curr Opin Gastroenterol, 2007, 23(5): 522534.
51.	Salvia R, Crippa S, Falconi M, et al. Branchduct intraductal papillary mucinous neoplasms of the pancreas: to operate or not to operate? [J]. Gut, 2007, 56(8): 10861090.
52.	Longnecker DS, Adler G, Hruban RH, et al. Intraductal papillary mucinous neoplasms of the pancreas//Hamilton SR, Aaltonen LA. World Health Organization classification of tumors. Pathology and genetics of tumors of the digestive system [M]. Lyon: IARC Press, 2000: 237241.
53.	Sarr MG, Murr M, Smyrk TC, et al. Primary cystic neoplasms of the pancreas. Neoplastic disorders of emerging importancecurrent stateoftheart and unanswered questions [J]. J Gastrointest Surg, 2003, 7(3): 417428.
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1. Beger HG, Witte C, Krautzberger W, et al. Experiences with duodenumsparing pancreas head resection in chronic pancreatitis [J]. Chirurg, 1980, 51(5): 303307.
2. Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis [J]. Pancreas, 1987, 2(6): 701707.
3. Müller MW, Friess H, Leitzbach S, et al. Perioperative and followup results after central pancreatic head resection (Berne technique) in a consecutive series of patients with chronic pancreatitis [J]. Am J Surg, 2008, 196(3): 364372.
4. Strobel O, Büchler MW, Werner J. Surgical therapy of chronic pancreatitis: indications, techniques and results [J]. Int J Surg, 2009, 7(4): 305312.
5. Varghese TK, Bell RH Jr. Duodenumpreserving head resection for chronic pancreatitis: an institutional experience and national survey of usage [J]. Surgery, 2007, 142(4): 588593.
6. Lee SE, Jang JY, Hwang DW, et al. Clinical efficacy of organpreserving pancreatectomy for benign or lowgrade malignant potential lesion [J]. J Korean Med Sci, 2010, 25(1): 97103.
7. Bell RH Jr. Atlas of pancreatic surgery//Bell RH Jr, Rikkers LF, Mulholland MW. Digestive trac surgery. A text and Atlas [M]. Philadelphia, PA: Lippincott Raven, 1996: 10141015.
8. Horiguchi A, Miyakawa S, Ishihara S, et al. Surgical design and outcome of duodenumpreserving pancreatic head resection for benign or lowgrade malignant tumors [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 792797.
9. 刘续宝, 肖乾虎. 腹部外科手术要点及围手术期处理 [M]. 北京: 科学出版社， 2010: 436437.
10. Kat’uchová J, Bober J, Závacky P. Chronic pancreatitis, indications for resection procedures and postoperative complications [J]. Rozhl Chir, 2008, 87(4): 200206.
11. Chirletti P, Peparini N, Caronna R, et al. RouxenY endtoend and endtoside double pancreaticojejunostomy: application of the reconstructive method of the Beger procedure to central pancreatectomy [J]. Langenbecks Arch Surg, 2010, 395(1): 8993.
12. Hatori T, Imaizumi T, Harada N, et al. Appraisal of the Imaizumi modification of the Beger procedure: the TWMU experience [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 752757.
13. Cataldegirmen G, Bogoevski D, Mann O, et al. Late morbidity after duodenumpreserving pancreatic head resection with bile duct reinsertion into the resection cavity [J]. Br J Surg, 2008, 95(4): 447452.
14. Beger HG, Schlosser W, Friess HM, et al. Duodenumpreserving head resection in chronic pancreatitis changes the natural course of the disease: a singlecenter 26year experience [J]. Ann Surg, 1999, 230(4): 512519.
15. Mihaljevic AL, Kleeff J, Friess H. Beger’s operation and the Berne modification: origin and current results [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 735744.
16. Gloor B, Friess H, Uhl W, et al. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis [J]. Dig Surg, 2001, 18(1): 2125.
17. Aspelund G, Topazian MD, Lee JH, et al. Improved outcomes for benign disease with limited pancreatic head resection [J]. J Gastrointest Surg, 2005, 9(3): 400409.
18. Farkas G, Leindler L, Daróczi M, et al. Prospective randomised comparison of organpreserving pancreatic head resection with pyloruspreserving pancreaticoduodenectomy [J]. Langenbecks Arch Surg, 2006, 391(4): 338342.
19. Riediger H, Adam U, Fischer E, et al. Longterm outcome after resection for chronic pancreatitis in 224 patients [J]. J Gastrointest Surg, 2007, 11(8): 949959.
20. Diener MK, Bruckner T, Contin P, et al. ChroPactrial: duodenumpreserving pancreatic head resection versus pancreatoduodenectomy for chronic pancreatitis. Trial protocol of a randomised controlled multicentre trial [J]. Trials, 2010, 11: 47.
21. Busquets J, Fabregat J, Borobia FG, et al. Organpreserving surgery for benign lesions and lowgrade malignancies of the pancreatic head: a matched casecontrol study [J]. Surg Today, 2010, 40(2): 125131.
22. 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) [J]. World J Surg, 2003, 27(11): 12171230.
23. 郑振江, 刘续宝, 麦刚, 等. 胰十二指肠切除术和保留十二指肠的胰头切除术治疗慢性胰腺炎的临床疗效比较 [J]. 四川大学学报（医学版） , 2008, 39(4): 686687.
24. Egawa S, Motoi F, Sakata N, et al. Assessment of Frey procedures: Japanese experience [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 745751.
25. Schneider CG, Cataldegirmen G, Mann O, et al. Lateral anastomosis techniques: PartingtonRochelle and Vshaped excision [J]. Chirurg, 2009, 80(1): 2833.
26. Strobel O, Büchler MW, Werner J. Duodenumpreserving pancreatic head resection: technique according to Beger, technique according to Frey and Berne modifications [J]. Chirurg, 2009, 80(1): 2227.
27. Andersen DK, Frey CF. The evolution of the surgical treatment of chronic pancreatitis [J]. Ann Surg, 2010, 251(1): 1832.
28. Ebbehj N, Borly L, Bülow J, et al. Pancreatic tissue fluid pressure in chronic pancreatitis. Relation to pain, morphology, and function [J]. Scand J Gastroenterol, 1990, 25(10): 10461051.
29. Di Sebastiano P, di Mola FF, Bockman DE, et al. Chronic pancreatitis: the perspective of pain generation by neuroimmune interaction [J]. Gut, 2003, 52(6): 907911.
30. Zhu ZW, Friess H, Wang L, et al. Brainderived neurotrophic factor (BDNF) is upregulated and associated with pain in chronic pancreatitis [J]. Dig Dis Sci, 2001, 46(8): 16331639.
31. Beger HG, Schlosser W, Poch B, et al. Inflammatory mass in the head of pancreas//Beger HG, Warshaw AL, Büchler MW， et al. The pancreas [M]. Oxford: Blackwell Science, 1998: 757760.
32. Schlosser W, Siech M, Grich J, et al. Common bile duct stenosis in complicated chronic pancreatitis [J]. Scand J Gastroenterol, 2001, 36(2): 214219.
33. Heider TR, Azeem S, Galanko JA, et al. The natural history of pancreatitisinduced splenic vein thrombosis [J]. Ann Surg, 2004, 239(6): 876880.
34. Rieder S, Michalski CW, Friess H. Indications for endoscopic or surgical treatment of chronic pancreatitis [J]. Dig Dis, 2010, 28(2): 344349.
35. Isaji S. Has the Partington procedure for chronic pancreatitis become a thing of the past? A review of the evidence [J]. J Hepatobiliary Pancreat Sci, 2010, 17(6): 763769.
36. Menge BA, Schrader H, Breuer TG, et al. Metabolic consequences of a 50% partial pancreatectomy in humans [J]. Diabetologia, 2009, 52(2): 306317.
37. 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 [J]. Ann Surg, 2008, 247(6): 950961.
38. Mihaljevic AL, Kleeff J, Friess H, et al. Surgical approaches to chronic pancreatitis [J]. Best Pract Res Clin Gastroenterol, 2008, 22(1): 167181.
39. Bachmann K, Kutup A, Mann O, et al. Surgical treatment in chronic pancreatitis timing and type of procedure [J]. Best Pract Res Clin Gastroenterol, 2010, 24(3): 299310.
40. Müller MW, Friess H, Martin DJ, et al. Longterm followup of a randomized clinical trial comparing Beger with pyloruspreserving Whipple procedure for chronic pancreatitis [J]. Br J Surg, 2008, 95(3): 350356.
41. McClaine RJ, Lowy AM, Matthews JB, et al. A comparison of pancreaticoduodenectomy and duodenumpreserving head resection for the treatment of chronic pancreatitis [J]. HPB (Oxford), 2009, 11(8): 677683.
42. Strate T, Taherpour Z, Bloechle C, et al. Longterm followup of a randomized trial comparing the beger and frey procedures for patients suffering from chronic pancreatitis [J]. Ann Surg, 2005, 241(4): 591598.
43. Malka D, Hammel P, Sauvanet A, et al. Risk factors for diabetes mellitus in chronic pancreatitis [J]. Gastroenterology, 2000, 119(5): 13241332.
44. Izbicki JR, Bloechle C, Knoefel WT, et al. Duodenumpreserving resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized trial [J]. Ann Surg, 1995, 221(4): 350358.
45. Keck T, Wellner UF, Riediger H, et al. Longterm outcome after 92 duodenumpreserving pancreatic head resections for chronic pancreatitis: comparison of Beger and Frey procedures [J]. J Gastrointest Surg, 2010, 14(3): 549556.
46. Keck T, Marjanovic G, Fernandezdel Castillo C, et al. The inflammatory pancreatic head mass: significant differences in the anatomic pathology of German and American patients with chronic pancreatitis determine very different surgical strategies [J]. Ann Surg, 2009, 249(1): 105110.
47. Amudhan A, Balachandar TG, Kannan DG, et al. Factors affecting outcome after Frey procedure for chronic pancreatitis [J]. HPB (Oxford), 2008, 10(6): 477482.
48. 刘续宝, 龚军. 慢性胰腺炎的手术治疗方式 [J]. 临床外科杂志， 2009, 17(6): 378380.
49. Uguz A, Yakan S, Gurcu B, et al. Xanthogranulomatous pancreatitis treated by duodenumpreserving pancreatic head resection [J]. Hepatobiliary Pancreat Dis Int, 2010, 9(2): 216218.
50. Beger HG, Rau BM. New advances in pancreatic surgery [J]. Curr Opin Gastroenterol, 2007, 23(5): 522534.
51. Salvia R, Crippa S, Falconi M, et al. Branchduct intraductal papillary mucinous neoplasms of the pancreas: to operate or not to operate? [J]. Gut, 2007, 56(8): 10861090.
52. Longnecker DS, Adler G, Hruban RH, et al. Intraductal papillary mucinous neoplasms of the pancreas//Hamilton SR, Aaltonen LA. World Health Organization classification of tumors. Pathology and genetics of tumors of the digestive system [M]. Lyon: IARC Press, 2000: 237241.
53. Sarr MG, Murr M, Smyrk TC, et al. Primary cystic neoplasms of the pancreas. Neoplastic disorders of emerging importancecurrent stateoftheart and unanswered questions [J]. J Gastrointest Surg, 2003, 7(3): 417428.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Application of Beger Procedure and Frey Procedure for Benign Disease or Low-Grade Malignant Potential Lesion of Pancreas

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