title: Pancreas-sparing duodenectomy is effective management for familial adenomatous polyposis.
abstract: Duodenal adenocarcinoma remains the leading cause of cancer death in familial adenomatous polyposis patients following colectomy. Stratification based on Spigelman's criteria provides a means for determining therapy. Spigelman stage IV patients have been selected for pancreas-sparing duodenectomy. Twenty-one patients underwent resection between 1992 and 2004, with a mean age of 58 +/- 11 years. The mean time from colectomy to duodenectomy was 27 +/- 13 years. Invasive cancer was found in the distal duodenum in one patient. Operative time averaged 327 +/- 61 minutes with a mean blood loss of 503 +/- 266 ml. There was no mortality, and eight patients (38%) had 14 complications: six (29%) with delayed gastric emptying, four (19%) with biliary/pancreatic anastomotic leak, one with pancreatitis, and one with wound infection. There were two reoperations: one for delayed gastric emptying and one for an early biliary leak. Mean length of stay was 15 +/- 10 days. Two late complications occurred: a stomal ulcer and an intestinal obstruction at 48 and 24 months, respectively. Mean follow-up was 79 months (range, 3-152 months). Two patients developed polyps in the advanced jejunal limb and were endoscopically treated. Pancreas-sparing duodenectomy represents a definitive treatment for advanced duodenal polyposis and can obviate the need for pancreaticoduodenectomy.
authors.affiliation: Department of General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Mackey
authors.forename: R Matthew
authors.initials: RM
authors.lastname: Walsh
authors.forename: Raphael
authors.initials: R
authors.lastname: Chung
authors.forename: Nancy
authors.initials: N
authors.lastname: Brown
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.forename: James
authors.initials: J
authors.lastname: Church
authors.forename: Carol
authors.initials: C
authors.lastname: Burke
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000473:pathology / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications; D016896:Treatment Outcome