Pancreas sparing duodenectomy in the treatment of primary duodenal neoplasms and other situations with duodenal involvement

Published on Mar 9, 2021in Hepatobiliary & Pancreatic Diseases International3.78
· DOI :10.1016/J.HBPD.2021.02.007
Juli Busquets19
Estimated H-index: 19
(University of Barcelona),
Josefina Lopez-Dominguez1
Estimated H-index: 1
(University of Barcelona)
+ 5 AuthorsJuan Fabregat19
Estimated H-index: 19
(University of Barcelona)
Abstract Background There are no clearly defined indications for pancreas-preserving duodenectomy. The present study aimed to analyze postoperative morbidity and the outcomes of patients undergoing pancreas-preserving duodenectomy. Methods Patients undergoing pancreas-preserving duodenectomy from April 2008 to May 2020 were included. We divided the series according to indication: scenario 1, primary duodenal tumors; scenario 2, tumors of another origin with duodenal involvement; and scenario 3, emergency duodenectomy. Results We included 35 patients. Total duodenectomy was performed in 1 patient of adenomatous duodenal polyposis, limited duodenectomy in 7, and third + fourth duodenal portion resection in 27. The indications for scenario 1 were gastrointestinal stromal tumor (n = 13), adenocarcinoma (n = 4), neuroendocrine tumor (n = 3), duodenal adenoma (n = 1), and adenomatous duodenal polyposis (n = 1); scenario 2: retroperitoneal desmoid tumor (n = 2), recurrence of liposarcoma (n = 2), retroperitoneal paraganglioma (n = 1), neuroendocrine tumor in pancreatic uncinate process (n = 1), and duodenal infiltration due to metastatic adenopathies of a germinal tumor with digestive hemorrhage (n = 1); and scenario 3: aortoenteric fistula (n = 3), duodenal trauma (n = 1), erosive duodenitis (n = 1), and biliopancreatic limb ischemia (n = 1). Severe complications (Clavien-Dindo ≥ IIIb) developed in 14% (5/35), and postoperative mortality was 3% (1/35). Conclusions Pancreas-preserving duodenectomy is useful in the management of primary duodenal tumors, and is a technical option for some tumors with duodenal infiltration or in emergency interventions.
#2Paula Ferrada (VCU: Virginia Commonwealth University)H-Index: 25
Although duodenal injuries are a rare entity of all trauma, they carry high risk of morbidity and mortality. The management of duodenal injuries should encompass a multidisciplinary approach. Optimal operative management of duodenal injuries has evolved in the last few decades. Isolated duodenal injuries are rare due to its proximity to major vascular and organ structures. Immediate mortality from duodenal injuries is due to hemorrhage from major vascular injuries. Non-operative management of is...
#1Alberto Aiolfi (SC: University of Southern California)H-Index: 22
#2Kazuhide Matsushima (SC: University of Southern California)H-Index: 22
Last. Demetrios Demetriades (SC: University of Southern California)H-Index: 114
view all 8 authors...
Background Surgical management of traumatic duodenal injury remains challenging. While various surgical techniques have been described in the attempt to reduce complications and mortality, recent data suggests that surgical approach using less invasive procedures might be associated with improved patient outcomes. The purpose of this study was to determine the recent trend of surgical procedures performed for patients with duodenal injury and their outcome.
BACKGROUND: Ideal surgical treatment for acute duodenal injuries should offer a definitive treatment, with low morbidity and mortality. It should be simple and easily reproducible by acute care surgeons in an emergency. Duodenal injury, due to major perforated or bleeding peptic ulcers or iatrogenic/traumatic perforation, represents a surgical challenge, with high morbidity and mortality. The aim was to review definitive surgery with pancreas-sparing, ampulla-preserving duodenectomy for these pa...
#1Taro Sakamoto (JFCR: Japanese Foundation for Cancer Research)H-Index: 2
#2Akio Saiura (JFCR: Japanese Foundation for Cancer Research)H-Index: 38
Last. Hiromichi Ito (JFCR: Japanese Foundation for Cancer Research)H-Index: 10
view all 8 authors...
Background Duodenal adenocarcinoma (DA) is a rare disease, and the optimal extent of lymphadenectomy and the role of limited resection remain controversial.
#1Yusuke NakayamaH-Index: 6
#2Masaru KonishiH-Index: 46
Last. Shinichiro TakahashiH-Index: 47
view all 11 authors...
Purpose Pancreas-sparing duodenectomy (PSD) represents an alternative procedure to pancreatoduodenectomy (PD) for patients with duodenal neoplasms.
#1Yuichiro Watanabe (Saitama Medical University)H-Index: 2
#2Hideyuki Ishida (Saitama Medical University)H-Index: 26
Last. Hideki IshikawaH-Index: 47
view all 7 authors...
Duodenal cancer is a leading cause of death in patients with familial adenomatous polyposis (FAP). In patients with Spigelman’s classification (SC) stage IV duodenal polyposis (DP), careful endoscopic surveillance by specialists or surgical intervention is mandatory. We herein report the surgical and pathological outcomes of FAP patients with SC stage duodenal polyposis undergoing pancreas-sparing total duodenectomy (PSTD), which has been rarely reported but seems optimal in such patients. PSTD ...
#1Jordan M. Cloyd (University of Texas MD Anderson Cancer Center)H-Index: 22
Duodenal adenocarcinoma is a rare but aggressive malignancy. Given its rarity, previous studies have traditionally combined duodenal adenocarcinoma (DA) with either other periampullary cancers or small bowel adenocarcinomas, limiting the available data to guide treatment decisions. Nevertheless, management primarily involves complete surgical resection when technically feasible. Surgery may require pancreaticoduodenectomy or segmental duodenal resection; either are acceptable options as long as ...
#1Anneke P. J. Jilesen (AMC: Academic Medical Center)H-Index: 9
#2Casper H.J. van Eijck (EUR: Erasmus University Rotterdam)H-Index: 72
Last. Els J. M. Nieveen van Dijkum (AMC: Academic Medical Center)H-Index: 15
view all 6 authors...
Studies on postoperative complications and survival in patients with pancreatic neuroendocrine tumors (pNET) are sparse and randomized controlled trials are not available. We reviewed all studies on postoperative complications and survival after resection of pNET. A systematic search was performed in the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE from 2000–2013. Inclusion criteria were studies of resected pNET, which described postoperative complications separately for ea...
#1Thomas J. Schroeppel (UTHSC: University of Tennessee Health Science Center)H-Index: 19
#2Kashif Saleem (UTHSC: University of Tennessee Health Science Center)H-Index: 1
Last. Timothy C. FabianH-Index: 99
view all 8 authors...
Multiple techniques are used for repair in duodenal injury ranging from simple suture repair for low-grade injuries to pancreaticoduodenectomy for complicated high-grade injuries. Drains, both intraluminal and extraluminal, are placed variably depending on associated injuries and confidence with the repair. It is our contention that a simplified approach to repair will limit complications and mortality. The major complication of duodenal leak (DL) was the outcome used to assess methods of repair...
This is a recommended management algorithm from the Western Trauma Association addressing the diagnostic evaluation and management of esophageal injuries in adult patients. Because there is a paucity of published prospective randomized clinical trials that have generated Class I data, the recommendations herein are based primarily on published observational studies and expert opinion of Western Trauma Association members. The algorithms and accompanying comments represent a safe and sensible app...
Cited By0
#1Atsushi Nanashima (University of Miyazaki)H-Index: 29
#2Yukinori Tanoue (Nagasaki University)H-Index: 2
Last. Yuichiro Sato (University of Miyazaki)H-Index: 24
view all 13 authors...
INTRODUCTION Duodenal adenocarcinoma is a rare malignancy; recently, it has been found to be accompanied by operative indications. METHODS Nine consecutive rare cases were diagnosed with duodenal carcinoma (DC), in which clinicopathological characteristics were retrospectively examined. Age was ranged over middle-aged males and females. No clinical onset with severe symptoms was observed, and the specific treatment for accompanied diseases or habits was not found. OUTCOMES One case of two T1 sta...
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