Severe duodenal involvement in familial adenomatous polyposis treated by pylorus-preserving pancreaticoduodenectomy.
OBJECTIVE
Pancreaticoduodenectomy is an alternative to pancreas-sparing duodenectomy for radical treatment of duodenal lesions. The aims of this study were to assess the results of pylorus-preserving pancreaticoduodenectomy (PPPD) for severe duodenal polyposis in familial adenomatous polyposis in terms of morbidity, long-term influence on functional results, the recurrence rate of cancer or jejunal polyps, and survival.


METHODS
All patients operated on for a PPPD between 1992 and 2009 were included. Clinical data, endoscopic findings, and pathologic examinations were evaluated.


RESULTS
A total of 19 patients underwent PPPD for severe duodenal polyposis (17 Spigelman IV, 1 Spigelman III, and 1 invasive carcinoma). Postoperative mortality was nil. The postoperative morbidity rate was 42%, including 4 pancreatic fistulae (21%) and 2 delayed gastric emptying (11%). Pathologic examination found 7 invasive carcinomas, of which only 1 was known before resection. One third of patients operated on without a preoperative diagnosis of malignancy already had an invasive duodenal carcinoma. After a mean follow-up of 58 months, 16 patients were alive. Thirteen patients underwent endoscopic follow-up, and new adenomas were found in 4 (31%). All were treated successfully during the same endoscopic procedure. PPPD did not modify the functional result after coloproctectomy.


CONCLUSIONS
PPPD remains a safe and efficient therapeutic option for severe duodenal polyposis in familial adenomatous polyposis patients.
Department of Digestive Surgery, Hôpital Saint Antoine, Paris, France.
Frédéric
F
Caillié
François
F
Paye
Benoit
B
Desaint
Malika
M
Bennis
Jérémie H
JH
Lefèvre
Yann
Y
Parc
Magali
M
Svrcek
Pierre
P
Balladur
Emmanuel
E
Tiret
D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D007580:Jejunal Neoplasms / Q000473:pathology*; D007902:Length of Stay; D008297:Male; D059351:Organ Sparing Treatments; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011708:Pylorus / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome