Pancreas-preserving limited duodenal resection: Minimizing morbidity without compromising oncological adequacy

Abstract

Backgrounds/Aims: Pancreaticoduodenectomy is the most common procedure for the management of duodenal pathologies. However, it is associated with substantial morbidity and a low risk of mortality. Pancreas-preserving limited duodenal resection (PPLDR) can be performed under specific scenarios. We share our experience with PPLDR and its outcome. Methods: We retrospectively analyzed a prospectively maintained database of patients undergoing limited duodenal resection in the form of wedge (sleeve) resection or segmental resection of one or more duodenal segments from March 2016 to March 2021 at a tertiary care center in North India. Results: During the study period, 10 patients (including 9 males) underwent PPLDR. Five of these 10 patients showed primary duodenal or proximal jejunal pathology, while the remaining five had duodenal pathology involving an adjacent organ tumor. Four patients underwent wedge (sleeve) resection, while the remaining six underwent segmental duodenal resection of one or more duodenal segments. Mean hospital stay was 6 days (range, 3-11 days) without 30-day mortality. Morbidity occurred in 4 patients (Grade I-II, n = 3; Grade III, n = 1). All patients were alive and disease-free at the time of last follow-up. The mean follow-up duration was 23 months (range, 2-48 months). Conclusions: PPLDR is a safe and effective alternative for pancreaticoduodenectomy when selected carefully for specific tumor types and location.

Resectable distal duodenal gastrointestinal stromal tumour presenting with features of anaemia

“…Side-to-side duodenojejunostomy is a technically easier procedure, owing to wide stoma and sparing of mesenteric side. [ 12 ] Lastly, it was left to determine the oncological adequacy in terms of short- and long-term survival, recurrence and metastasis.…”

Gallbladder cancer: Progress in the Indian subcontinent

“…They concluded that duodenal infiltration does not serve as a sign of unresectability or a reason to undergo HPD. For the majority of these patients, a distal gastrectomy combined with resection of the first segment of the duodenum, or a duodenal sleeve resection can accomplish an oncologically appropriate R0 resection[ 178 ].…”