title: Limited Resection of the Duodenum for Nonampullary Duodenal Tumors, with Review of the Literature.
abstract: The surgical management of duodenal pathology is challenging because of its retroperitoneal position and shared blood supply with the pancreas. We present three types of limited resection of the duodenum for the removal of superficial or small nonampullary duodenal (NADL) lesions, and also a review of the English literature regarding management, such as endoscopic resection and limited duodenal resection. Ten cases underwent limited resections of the duodenum for superficial or small NADL lesions from 2011 to 2015. Pancreas-preserving segmental duodenectomy was performed in three cases, local full-thickness resection was performed in three and transduodenal submucosal dissection was performed in four. One patient experienced pancreatic fistula as a postoperative complication. Postoperative pathological diagnosis were adenoma (n = 2), mucosal adenocarcinomas (n = 5), and neuroendocrine tumor (n = 3). Surgical margin was negative in all cases, and no patient has experienced postoperative recurrence or metastasis. Limited resections of the duodenum were feasible and safe procedures for patients with superficial or small NADL lesions. Laparoscopic surgery may be considered in treatment for these tumors. However, the optimal surgical management for superficial or small nonampullary duodenal lesions remains controversial.
authors.affiliation: Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hashimoto
authors.forename: Kota
authors.initials: K
authors.lastname: Arima
authors.forename: Akira
authors.initials: A
authors.lastname: Chikamoto
authors.forename: Katsunobu
authors.initials: K
authors.lastname: Taki
authors.forename: Risa
authors.initials: R
authors.lastname: Inoue
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Kaida
authors.forename: Takaaki
authors.initials: T
authors.lastname: Higashi
authors.forename: Katsunori
authors.initials: K
authors.lastname: Imai
authors.forename: Toru
authors.initials: T
authors.lastname: Beppu
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018278:Carcinoma, Neuroendocrine / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000379:methods; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology