title: Extraduodenal papillectomy: a feasible alternative method of total papillectomy.
abstract: Rational treatment for neoplasms of the duodenal papilla (NDPs) is still controversial, especially for early stage lesions. Total papillectomies are indicated in patients expected to have adenomas, adenocarcinoma in an adenoma, or mucosal adenocarcinomas with no lymph node metastases. However, the preoperative pathological evaluation of NDPs is still challenging and often inaccurate, mainly because of the complicated anatomical structures involved and the possibility of an adenocarcinoma in an adenoma. Herein, we introduce a new method of total papillectomy, the extraduodenal papillectomy (ExDP). In this method, papillectomy is undertaken from outside of the duodenum, instead of resection from the inside through a wide incision of the duodenal wall as is done in conventional transduodenal papillectomy (TDP). The advantages of ExDP are precise and deeper cutting of the sphincter and shorter exploration time of the tumor compared to conventional TDP. We demonstrate three representative patients, all of whom had an uneventful postoperative course. One of them subsequently underwent a pylorus preserving pancreatoduodenectomy after detailed postoperative pathological evaluation. Including that patient, no recurrence has occurred with 37-46 months of follow-up. In conclusion, ExDP is regarded as a "total biopsy" for early stage borderline lesions and a feasible, less demanding alternative method for the treatment of NDPs.
authors.affiliation: Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan, sata@jichi.ac.jp.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Sata
authors.forename: Masaru
authors.initials: M
authors.lastname: Koizumi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kaneda
authors.forename: Yasunao
authors.initials: Y
authors.lastname: Ishiguro
authors.forename: Akira
authors.initials: A
authors.lastname: Kurogochi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Endo
authors.forename: Hideki
authors.initials: H
authors.lastname: Sasanuma
authors.forename: Yasunaru
authors.initials: Y
authors.lastname: Sakuma
authors.forename: Alan
authors.initials: A
authors.lastname: Lefor
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yasuda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D001650:Bile Duct Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged