Is there an advantage in performing a pancreas-preserving total duodenectomy in duodenal adenomatosis?
BACKGROUND
Duodenal adenomatosis is a premalignant condition often not treatable by local resection or endoscopy. An option for treatment is a pylorus-preserving (pp)-Whipple resection. Since the introduction of pancreas-preserving total duodenectomy (PPTD), the question has arisen whether a pp-Whipple resection is still needed to treat duodenal adenomatosis.


METHODS
In a 5-year period 23 PPTDs were performed for duodenal adenomatosis. In a matched-pairs analysis the outcome following PPTD (16 patients with a follow-up longer than 12 months) was compared with pp-Whipple.


RESULTS
Hospital mortality in all 23 patients was 4.3% and total morbidity 30% after PPTD. Operation time, intensive care and hospital stay, morbidity, and mortality were comparable between the matched paired groups (16 patients). Patients with PPTD had significantly lower intraoperative blood loss. No PPTD patient required pancreatic enzyme substitution, compared with 12 patients after pp-Whipple. Quality-of-life analysis in PPTD patients revealed no difference compared to a normal control population and the pp-Whipple group.


CONCLUSIONS
PPTD is a safe surgical procedure for duodenal adenomatosis that avoids pancreatic head resection, provides high quality of life, and shows advantages over the pp-Whipple procedure.
Müller
Michael W
MW
Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, D-81675 Munich, Germany.
Dahmen
Rolf
R
Köninger
Jörg
J
Michalski
Christoph W
CW
Hinz
Ulf
U
Hartel
Mark
M
Kadmon
Martina
M
Kleeff
Jörg
J
Büchler
Markus W
MW
Friess
Helmut
H
D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures; D004379:Duodenal Neoplasms / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011230:Precancerous Conditions / Q000601:surgery*; D011788:Quality of Life