Operative management of primary duodenal masses: is a limited resection actually safer?

The operative management of duodenal tumors remains controversial with outcomes comparing pancreatoduodenectomy (PD) versus duodenectomy arising from small, noncontemporary cohorts. The aim of this study is to examine perioperative outcomes between PD and duodenectomy for duodenal masses. It is hypothesized that the morbidity profile of a duodenectomy lies between that of a PD and that of an enterectomy for a distal small bowel tumor.

A single-institution retrospective review was performed of patients with non-ampullary duodenal tumors who underwent PD or duodenectomy between 2006 and 2025. Duodenectomy was classified as proximal (D1/D2) versus distal (D3/D4) duodenectomy based on tumor location. Patients who underwent enterectomy for jejunal/ileal tumors were identified as another comparison group. The primary outcome was 30-day major morbidity, defined as a composite of core complications (delayed oral feeding autonomy, abscess, anastomotic leak, bleeding requiring intervention, reoperation) and was evaluated across four cohorts: PD vs. proximal duodenectomy vs. distal duodenectomy vs. enterectomy.

The analytic cohort consisted of 235 patients: PD = 86 (36.6%), proximal duodenectomy = 39 (16.6%), distal duodenectomy = 45 (19.1%), enterectomy = 65 (27.7%). Among patients who underwent duodenectomy, 23 (27.4%) underwent a local excision, and 61 (72.6%) underwent a segmental resection. 76 (32.3%) patients suffered major morbidity. Major morbidity rates were the following: PD = 47.7% vs. proximal duodenectomy = 30.8% vs. distal duodenectomy = 35.6% vs. enterectomy = 10.8% (p < 0.001). Adjusting for covariates, proximal [OR: 3.76, 95% CI: (1.21, 11.7), p = 0.022] and distal [OR: 3.77, 95% CI: (1.44, 9.87), p = 0.007] duodenectomy were associated with a higher likelihood of morbidity relative to enterectomy.

Duodenectomy for duodenal masses may be performed for select non-ampullary tumors and is associated with a considerable profile that is higher than that of enterectomy for distal small bowel tumors. Therefore, duodenectomy merits consideration as a distinct procedural service.