Non-Whipple Operations in the Management of Benign, Premalignant and Early Cancerous Duodenal Lesions.
We reviewed our 20-year experience with non-Whipple operations (pancreas-preserving duodenectomy and transduodenal ampullectomy) for the treatment of benign, premalignant or early-stage malignant duodenal lesions.



Twenty-four patients who underwent non-Whipple operations between January 1996 and December 2015 were identified from an institutional database and retrospectively analyzed.



Between 1996 and 2015, 10 patients underwent pancreas-preserving duodenectomy and 14 patients underwent transduodenal ampullectomy. The mean follow-up was 25.8 months (range=6-54 months) and no patient was lost to follow-up. Eighteen patients had preoperative diagnosis of duodenal adenomatosis, three patients had preoperative diagnosis of duodenal adenocarcinoma, one had a bleeding polyp and two had localized inflammation. Average operative time was 145 min (range=127-168 min) for transduodenal ampullectomy and 183 min (range=173-200 min) for pancreas-preserving duodenectomy (p<0.05). The estimated blood loss for transduodenal ampullectomy was 85 vs. 125 ml for pancreas-preserving duodenectomy (p<0.05). Early postoperative complications were noted in 13 cases (54.17%). There were no postoperative (90-day) deaths observed in this series and there were no recurrences during follow-up for the patients operated on with neoplastic lesions.



For carefully selected patients, transduodenal ampullectomy and pancreas-preserving duodenectomy may be used in place of the Whipple operation for benign and occasionally early-stage malignant (Tis and T1) duodenal and ampullary disease.
First Department of Surgery, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Alexandros
A
Papalampros
First Department of Surgery, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece dimmoris@yahoo.com.|Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH, U.S.A.
Demetrios
D
Moris
Nicosia Surgical Department, Division of Hepatobiliary Pancreatic Surgery, Nicosia General Hospital, Nicosia, Cyprus.
Athanasios
A
Petrou
First Department of Surgery, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Nikolaos
N
Dimitrokallis
First Department of Surgery, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Ioannis
I
Karavokyros
First Department of Surgery, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Dimitrios
D
Schizas
Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Ioanna
I
Delladetsima
Department of Surgery, Duke University, Durham, NC, U.S.A.
Theodore N
TN
Pappas
First Department of Surgery, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Evangelos
E
Felekouras
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D000714:Anastomosis, Surgical; D003657:Decision Making; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D061646:Operative Time; D011183:Postoperative Complications; D012189:Retrospective Studies; D000071077:Surgical Oncology / Q000379:methods; D016896:Treatment Outcome
Pancreas-preserving duodenectomy; ampullary lesions; pancreatoduodenectomy; surgical ampullectomy