title: Pancreaticoduodenectomy for advanced duodenal and ampullary adenomatosis in familial adenomatous polyposis.
abstract: BACKGROUND
  Patients with familial adenomatous polyposis (FAP) develop duodenal and ampullary polyps that may progress to malignancy via the adenoma-carcinoma sequence.
  
  
  OBJECTIVE
  The aim of this study was to review a large series of FAP patients undergoing pancreaticoduodenectomy for advanced duodenal and ampullary polyposis.
  
  
  METHODS
  A retrospective case notes review of all FAP patients undergoing pancreaticoduodenectomy for advanced duodenal and ampullary adenomatosis was performed.
  
  
  RESULTS
  Between October 1993 and January 2010, 38 FAP patients underwent pancreaticoduodenectomy for advanced duodenal and ampullary polyps. Complications occurred in 29 patients and perioperative mortality in two. Postoperative histology revealed five patients to have preoperatively undetected cancer (R = 0.518, P < 0.001).
  
  
  CONCLUSIONS
  Pancreaticoduodenectomy in FAP is associated with significant morbidity, but low mortality. All patients under consideration for operative intervention require careful preoperative counselling and optimization.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Royal Free Hampstead National Health Service (NHS) Trust, London, UK. j.skipworth@ucl.ac.uk
authors.forename: James R A
authors.initials: JR
authors.lastname: Skipworth
authors.forename: Clare
authors.initials: C
authors.lastname: Morkane
authors.forename: Dimitri Aristotle
authors.initials: DA
authors.lastname: Raptis
authors.forename: Soumil
authors.initials: S
authors.lastname: Vyas
authors.forename: Steven W
authors.initials: SW
authors.lastname: Olde Damink
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Imber
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Pereira
authors.forename: Massimo
authors.initials: M
authors.lastname: Malago
authors.forename: Nicholas
authors.initials: N
authors.lastname: West
authors.forename: Robin K S
authors.initials: RK
authors.lastname: Phillips
authors.forename: Sue K
authors.initials: SK
authors.lastname: Clark
authors.forename: Arjun
authors.initials: A
authors.lastname: Shankar
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008131:London; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome