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Pancreas-sparing duodenectomy for duodenal polyposis
Juan M Sarmiento1, Geoffrey B Thompson, David M Nagorney
1Division of Gastroenterological and General Surgery, Mayo Clinic and Mayo Foundation, 200 First St SW, Rochester, MN 55905, USA.
Hypothesis:
Pancreas-sparing duodenectomy (PSD) is a safe and effective operative procedure for patients with nonmalignant duodenal polyps.
Design:
Retrospective analysis of outcomes in patients undergoing PSD.
Setting:
A tertiary referral center.
Patients:
All patients undergoing PSD at the Mayo Clinic, Rochester, Minn. Indications were the presence of numerous duodenal polyps or large, solitary, adenomatous polyps not amenable to endoscopic resection. Dysplasia without frank malignancy was demonstrated in all patients by endoscopic biopsy specimens. Follow-up was complete in all patients.
Main Outcome Measures:
Operative feasibility, short- and long-term complications, quality of life, and survival.
Results:
Five patients had diffuse polyposis (familial adenomatous polyposis) and 3 had very large periampullary villous adenomas. The mean age of the patients was 54 years (female-male ratio, 3:1). Colectomy preceded PSD in 5 patients (familial adenomatous polyposis); 3 had previous transduodenal excision of adenomas, and 2 had previous resections of desmoid tumors. The mean operating room time was 370 minutes; blood loss, 340 mL; and the length of the hospital stay, 18 days. All specimens showed dysplasia (5 low grade, 3 high grade). There were 5 major complications--3 ampullary leaks that closed spontaneously with drainage, 1 intra-abdominal hemorrhage requiring a second exploratory surgical procedure, and 1 deep wound infection. The mean follow-up was 23 months. All patients experienced weight gain and good performance status. A second endoscopy (performed in 5 patients) demonstrated small polyps in the neoduodenum in 2 patients and tiny anastomotic ulcers in 2 patients. For 1 patient, there were no abnormalities seen on the endoscopy. Two patients have since developed transient bouts of pancreatitis.
Conclusions:
Pancreas-sparing duodenectomy, although technically demanding, eliminates the need for pancreatic resection. Pancreas-sparing duodenectomy is associated with good absorptive capacity, weight gain, and quality of life. Furthermore, it may reduce the risk of subsequent malignancy. Long-term surveillance, however, is still required. Pancreas-sparing duodenectomy is contraindicated in the setting of malignancy.