title: Surgical management of the duodenal manifestations of familial adenomatous polyposis.
abstract: BACKGROUND
  Duodenal adenomas develop in patients with familial adenomatous polyposis, incurring a risk of carcinoma. When this risk is high, surgery is indicated. The choice of surgical treatment can be difficult as evidence-based data are lacking.
  
  
  METHODS
  This is a systematic review of the literature on the non-medical management of duodenal lesions arising in the setting of familial adenomatous polyposis. Studies were identified through searching MEDLINE. Studies published between January 1965 and October 2009 were included. Data regarding number of subjects, complications, length of follow-up, recurrence rate and outcome were extracted.
  
  
  RESULTS
  Transduodenal resection does not differ from an endoscopic approach in terms of recurrence. Ampullectomy has limited application as only papillary lesions are amenable to treatment in this manner. Duodenectomy with pancreas preservation is preferable to pancreaticoduodenectomy unless malignancy is present, or cannot be excluded.
  
  
  CONCLUSIONS
  Surgery should be reserved for advanced or malignant polyps.
authors.affiliation: Department of Digestive Surgery, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France. yann.parc@sat.aphp.fr
authors.forename: Y
authors.initials: Y
authors.lastname: Parc
authors.forename: J-Y
authors.initials: JY
authors.lastname: Mabrut
authors.forename: C
authors.initials: C
authors.lastname: Shields
mesh_terms: D000236:Adenoma / Q000601:surgery*; D011125:Adenomatous Polyposis Coli / Q000601:surgery; D004379:Duodenal Neoplasms / Q000601:surgery*; D004384:Duodenoscopy / Q000379:methods*; D004386:Duodenum / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D010180:Pancreatectomy / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome