Pancreas-sparing duodenectomy for infra-ampullary duodenal pathology.
BACKGROUND
Surgical management of distal duodenal pathology is challenging because of the duodenum's retroperitoneal location and its shared blood supply with the pancreas. For infra-ampullary pathology, surgical treatment may include local excision, pancreaticoduodenectomy, or pancreas-sparing duodenectomy (PSD).


METHODS
We retrospectively reviewed the management of 24 patients with infra-ampullary duodenal pathology treated by PSD between 1985 and 1994 at The Johns Hopkins Hospital.


RESULTS
There were 16 men and 8 women with a mean age of 51.2 +/- 4.4 years. The indications for elective PSD in 19 patients were neoplasms (n = 15), Crohn's disease (n = 2), and other (n = 2). Of the neoplasms, 13 were malignant (11 adenocarcinoma, 1 lymphoma, 1 liposarcoma) and 2 were being (1 villous adenoma, 1 benign stromal tumor). Five patients had PSD as an emergency procedure for penetrating trauma. The mean follow-up is 24.2 +/- 5.8 months (range 1 to 122). In the group undergoing elective PSD, the mean length of operation was 5.3 +/- 0.4 hours, and the estimated blood loss was 569 +/- 121 mL. In the entire series, there was 1 postoperative death from an anastomotic leak and 1 reexploration for anastomotic bleeding. Pancreas-sparing duodenectomy in patients with trauma or benign duodenal pathology resulted in a good outcome in all. In those 11 patients with duodenal adenocarcinoma, 7 have died, 2 have had recurrences, and 2 are disease free. Actuarial and disease-free, 2-year survival rates in the 11 patients with duodenal adenocarcinoma were 33% and 14%, respectively.


CONCLUSIONS
Pancreas-sparing duodenectomy is a safe and effective treatment in patients with distal duodenal benign neoplasms or trauma, and PSD appears to have limited effectiveness for malignant distal duodenal pathology.
Maher
M M
MM
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Yeo
C J
CJ
Lillemoe
K D
KD
Roberts
J R
JR
Cameron
J L
JL
D014670:Ampulla of Vater; D000714:Anastomosis, Surgical; D016063:Blood Loss, Surgical; D003424:Crohn Disease / Q000601:surgery; D004378:Duodenal Diseases / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000601:surgery; D004386:Duodenum / Q000293:injuries / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies