Hepato-gastroenterology · 2007
Pancreas-sparing duodenectomy for duodenal neoplasms including malignancies.
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Konishi Masaru, Kinoshita Taira, Nakagohri Toshio, Takahashi Shinichiro, Gotohda Naoto, Ryu Munemasa
Аннотация
BACKGROUND/AIMS: 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.
METHODOLOGY: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODOLOGY: 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.
RESULTS: 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.
CONCLUSIONS: 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.