Outcomes of Pancreas-Sparing Total Duodenectomy for Severe Duodenal Polyposis in Patients With Familial Adenomatous Polyposis.

AIM: Spigelman stage IV duodenal polyposis (SP-stage IV DP) is associated with high duodenal cancer risk in patients with familial adenomatous polyposis (FAP). This study evaluated the surgical and oncological outcomes of pancreas-sparing total duodenectomy (PSTD) as a surgical prophylaxis for severe duodenal polyposis in FAP.

METHODS

Medical records were reviewed to evaluate factors concerning short- and long-term clinical and oncological outcomes in consecutive patients with FAP who underwent PSTD for SP-stage IV DP.

RESULTS

There were twenty-seven patients (median age: 48 years) from 26 families, of whom 12 were female. Clavien-Dindo grade IIIa/IIIb complications included delayed gastric emptying (n = 14) and pancreatic fistula (n = 10); no mortalities were observed. Histopathological examinations revealed no malignant neoplasms deeper than T1a in the duodenum and ampulla. Follow-up (median 6.4 years) revealed anastomotic stricture of the reconstructed neo-common channel (n = 5), anastomotic ulcer of the gastrojejunostomy site (n = 5), acute pancreatitis (n = 4), and acute cholangitis (n = 2), all of which were successfully treated endoscopically or conservatively. Malignant neoplasms after PSTD included gastric cancer (n = 3), remnant ano-rectal cancer (n = 3), ileal cancer (n = 1), ileal pouch cancer (n = 1), and endometrial cancer (n = 1). The cumulative 10-year survival rate following PSTD was 87.4%.

CONCLUSIONS

PSTD for the prophylactic management of SP-stage IV DP was associated with notable but manageable postoperative morbidity. Long-term surveillance remains essential for the development of extraduodenal malignancies to confirm the oncological efficacy of this type of surgery.