Is transduodenal resection for duodenal adenomas adequate?

Abstract

Objective: Duodenal adenomas (DAs) are uncommon occurrences with malignant potential. The optimal surgical management of DAs remain controversial. Methods: We performed a retrospective review of 27 patients at a single institution who received either a Whipple procedure (40.7%) or a transduodenal resection (TDR) (59.3%) for ampullary and nonampullary duodenal adenomas. Perioperative and postoperative outcomes were compared between the two groups. Results: Both groups had similar demographics. Median operative time and median estimated blood loss (EBL) were longer in the Whipples group than the TDR group. Mean length of stay was longer in the Whipple group vs TDR group (12 vs 7 days). 3 patients (18.7%) who received TDRs developed recurrent adenomas. Two of these patients subsequently received a Whipple procedure. This is summarized in Table 1. Conclusion: Although TDR has the perioperative advantages of less operative time, less EBL and less hospital length of stay, our experience demonstrates that TDR may be inferior to the Whipple procedure for duodenal adenomas due to high recurrence rates.Table 1Whipple (n=11)Transduodenal resection (n=16)Median duration of surgery (min)248120Median estimated blood loss (mL)300100Mean length of stay (Days)137RecurrencesN/A18.7% Open table in a new tab