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.

中文翻译：

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胰腺保留十二指肠切除术治疗原发性十二指肠肿瘤和其他十二指肠受累情况

背景

保留胰十二指肠切除术没有明确的指征。本研究旨在分析接受保胰十二指肠切除术的患者的术后发病率和结局。

方法

纳入 2008 年 4 月至 2020 年 5 月接受保胰十二指肠切除术的患者。我们根据适应症对系列进行了划分：场景 1，原发性十二指肠肿瘤；情景 2，十二指肠受累的其他来源肿瘤；情景3，紧急十二指肠切除术。

结果

我们纳入了 35 名患者。十二指肠腺瘤性息肉病患者行十二指肠全切除术，7例行有限度十二指肠切除术，27例行第3次+第4次十二指肠部分切除术。方案1的适应症为胃肠道间质瘤（n  =13）、腺癌（n  =4）、神经内分泌肿瘤（n  = 3）、十二指肠腺瘤（n  = 1）和腺瘤性十二指肠息肉病（n  = 1）；情景2：腹膜后硬纤维瘤（n  = 2），脂肪肉瘤复发（n  = 2），腹膜后副神经节瘤（n  = 1），胰腺钩突神经内分泌肿瘤（n = 1)，以及由于消化道出血的生发肿瘤的转移性腺病引起的十二指肠浸润 ( n  = 1)；情景 3：主动脉肠瘘 ( n  = 3)、十二指肠外伤 ( n  = 1)、糜烂性十二指肠炎 ( n  = 1) 和胆胰肢体缺血 ( n  = 1)。14% (5/35) 出现严重并发症 (Clavien-Dindo ≥ IIIb)，术后死亡率为 3% (1/35)。

结论

保胰十二指肠切除术可用于治疗原发性十二指肠肿瘤，是一些十二指肠浸润肿瘤或紧急干预的技术选择。