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

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.

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.