Original Article/PancreasPancreas sparing duodenectomy in the treatment of primary duodenal neoplasms and other situations with duodenal involvement
Introduction
Pancreaticoduodenectomy (PD) is the technique of choice in the surgical treatment of malignant periampullary tumors and inflammatory disease of the head of the pancreas. The morbidity of this technique is not negligible and may present medium- and long-term sequelae. Different pancreas-preserving techniques such as duodenal-preserving pancreatectomy, ampullectomy or uncinectomy have been proposed for the treatment of benign pancreatic tumors or those of low malignancy potential [1], [2], [3]. Likewise, different options of duodenectomy without removal of the pancreas have been described [1,4]. However, the indications of pancreas-preserving duodenectomy have not been clearly established. Moreover, there are few studies in this regard, making it difficult to decide which technique is the most adequate in patients with non-infiltrating duodenal lesions and what technique is to be performed in emergency cases of irreversible duodenal pathology. Therefore, the aim of this study was to analyze the results of a retrospective series of pancreas-preserving duodenectomy.
Section snippets
Methods
We prospectively collected demographic, surgical and anatomopathologic data as well as data related to postoperative morbidity, mortality and long-term follow-up of patients undergoing pancreas-preserving duodenectomy performed in our center from April 2008 to May 2020. This study was approved by the Clinical Research Ethics Committee of Hospital Universitari de Bellvitge (PR260/19).
Results
From April 2008 to May 2020, 35 patients (21 men and 14 women) with a mean age of 59 years old underwent pancreas-preserving duodenectomy. Scenario 1 included 22 patients: 13 had a mesenchymal tumor (gastrointestinal stromal tumor, GIST), 4 duodenal adenocarcinoma, 3 duodenal neuroendocrine tumor, 1 duodenal adenoma, and 1 presented adenomatous duodenal polyposis. Scenario 2 included 7 patients: 2 cases of recurrence of retroperitoneal liposarcoma, 2 retroperitoneal desmoid tumor, 1 duodenal
Discussion
The high morbidity presented by patients following PD has led to the search for strategies aimed at minimizing the use of this procedure. Duodenectomy is performed with the aim of resecting the duodenum and avoiding extirpation of the head of the pancreas taking into account the inherent morbidity this implies [1,6,7]. Sauvanet et al. [8] stated that “pancreatic surgery should not be seen as the alternative between PD and distal resection”, and thus, pancreas-sparing techniques may be useful in
Acknowledgments
The authors thank Donna Elaine Pringle and Ariadna Busquets for reviewing the final draft of the manuscript for its content and English style.
CRediT authorship contribution statement
Juli Busquets: Conceptualization, Formal analysis, Investigation, Methodology, Writing - original draft, Writing - review & editing. Josefina Lopez-Dominguez: Data curation, Writing - review & editing. Ana Gonzalez-Castillo: Data curation. Marina Vila: Data curation. Nuria Pelaez: Data curation. Lluis Secanella: Software. Emilio Ramos: Supervision, Validation. Juan Fabregat: Funding acquisition, Supervision, Validation, Writing - review & editing.
Funding
This study was supported by grants from the Institut de Investigació Biomèdica de Bellvitge (IDIBELL Foundation) and the CERCA Programme/Generalitat de Catalunya.
Ethical approval
This study was approved by the Clinical Research Ethics Committee of Hospital Universitari de Bellvitge (PR260/19).
Competing interest
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
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