Pancreas-preserving segmental duodenectomy for duodenal malignancy: two case reports

The extent of resection required for duodenal malignancy has long been debatable. Compared with pancreaticoduodenectomy (PD), pancreas-preserving segmental duodenectomy (PPSD) is a less demolitive procedure that provides definitive treatment for a range of duodenal pathologies, including adenocarcinoma. However, the rarity of these malignancies limits large-scale clinical studies on the feasibility and safety of PPSD. Thus, case reports and small case series may provide some clinical guidance for this rare situation. We herein report two cases of patients with duodenal malignancy who were treated with PPSD. Case 1 was a 36-year-old female patient, who was diagnosed with adenocarcinoma of the hepatic flexure with synchronous invasion of the descending portion of the duodenum. After 4 cycles of neoadjuvant chemotherapy, she received radical right colectomy and PPSD. Case 2 was a 45-year-old male patient, who was found to have a metachronous metastasis in the horizontal portion of the duodenum 14 months after laparoscopic extended right colectomy with complete mesocolic excision for transverse colon adenocarcinoma. The duodenal lesion was confirmed by imaging, endoscopic, and pathological examinations. He received PPSD combined with a partial resection of the uncinate process of the pancreas. Postoperative pathology confirmed R0 resection in both cases, and both patients had an uneventful recovery. These cases provide further evidence supporting the feasibility and safety of PPSD for non-ampullary duodenal tumors. However, the long-term oncological outcomes are still unclear; therefore, further studies with longer follow-up and larger sample sizes are warranted.