Pancreas-sparing total duodenectomy for ampullary duodenal neoplasms.
BACKGROUND
Ampullary and extensive periampullary lesions can be difficult to treat and often require pancreaticoduodenectomy (PD) for complete removal, even if benign. However, PD may be overtreatment for noninvasive lesions, and pancreas-sparing total duodenectomy (PSTD) is an emerging valid surgical option for selected cases.


METHODS
We reviewed patients undergoing PSTD at our institution over 16 months and a comparison group who had undergone PD for benign duodenal disease over the past 15 years. We also reviewed cases in the English-language literature and performed a meta-analysis of those patients who had undergone PSTD.


RESULTS
PSTD had been performed in four patients, who had an average hospital length of stay (LOS) of 13 days; two of them experienced complications. None required conversion to PD, experienced a postoperative fistula or endocrine or exocrine insufficiency, or required intensive care. Two of the PSTDs were performed laparoscopically. Open PD for benign duodenal disease was performed in 22 patients, with overall morbidity and pancreas fistula rates of 82 and 27 %, respectively. The meta-analysis found 128 unique cases of PSTD with morbidity and mortality rates of 46.4 and 2.3 %, respectively. Pancreaticobiliary leak was seen in 20 %, with an average LOS of 17 days.


CONCLUSIONS
Although PSTD can be used to avoid PD and can be performed laparoscopically, it is technically challenging and still associated with morbidity.
Department of General Surgery, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA. stauffer.john@mayo.edu
John A
JA
Stauffer
Cameron D
CD
Adkisson
Douglas L
DL
Riegert-Johnson
Ross F
RF
Goldberg
Steven P
SP
Bowers
Horacio J
HJ
Asbun
D000236:Adenoma / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater; D013505:Digestive System Surgical Procedures / Q000379:methods; D004379:Duodenal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D044483:Intestinal Polyposis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010179:Pancreas; D012189:Retrospective Studies