Results of 27 pancreas – Preserving duodenectomies not associated with FAP

Abstract

Background: Pancreas – preserving duodenectomies (PPD) are uncommon procedures usually reserved for duodenal adenomas associated with familial adenomatous polyposis (FAP). PPDs performed for other entities are much more rare operations. Methods: To assess possibilitiy of PPD use for lesions not associated with FAP Prospective analysis of 27 consecutive cases of PPD (2006 – 2016). with assessment of preoperative (US,CT,MRI,EUS) and hystologiacal diagnosis, short- and long–term results, including QoL for benign and survival for malignancy Results: Duodenal dystrophy in 14 cases, duodenal GIST in 10 cases, villous adenoma, gigantic leiomyosarcoma, paraganglioma and solitary endometrial cancer metastasis in 1 case each were met. In 22 cases the diagnosis was established before surgery. The most precise diagnostic modalities were CT and EUS. The main symptoms were pain(12), GI bleeding(11) and vomiting(4). Infrapapillary duodenectomy(ID) was performed in 12 cases, one with aorta and inferior vena cava resections, and in 50% of cases duodenal resection with replantation of common bile and main pancreatic ducts in neoduodenum was performed. Morbidity rate 29%. One patient with duodenal sarcoma had died on 100th day after ID due to complications of pancreonecrosis. Other patients are alive demonstrating long-term survival and good QoL. Conclusion: Well-timed PPD is an efficient method of treatment as for benign so as for some malignant duodenal lesions and can be an alternative for pancreaticoduodenectomy.