Pancreas-sparing duodenectomy for duodenal neoplasms including malignancies

Pancreas-sparing duodenectomy (PSD) represents an attractive operation for benign or premalignant duodenal disease. However, use of PSD is controversial for indications that include malignancy.

The present study investigated 16 patients who underwent PSD for duodenal neoplasms including adenoma, cancer, carcinoid and non-epithelial tumor. Indications for PSD were divided into 3 categories: early stage neoplasms; isolated duodenal neoplasms in high-risk patients; and duodenal involvement from adjacent organ malignancies. This study classified PSD into 4 types based on the resected portion of the duodenum, as used in gastrectomy (total, subtotal, distal, and proximal) and we experienced pancreas-sparing proximal duodenectomy and pancreas-sparing distal duodenectomy.

Pancreatic fistula or anastomotic leak occurred in 2 patients, and were closed with nonoperative management. Although 1 patient with gallbladder cancer died postoperatively due to the results of a concomitant operation, no postoperative deaths or re-operations related to PSD were encountered. Mean duration of follow-up was 65 months. Three patients died as a result of distant metastases from primary cancer without local recurrence, and 2 patients died from other causes. The remaining 10 patients are well, with no symptoms related to the hepatobiliary and pancreatic systems.

Good results after long-term follow-up suggest that PSD represents an attractive option for duodenal neoplasms. Moreover, absence of local recurrence suggests that PSD may also be acceptable for selected duodenal malignancies.