Pancreas-sparing duodenectomy for infra-ampullary duodenal pathology

Maher, Michael M.; Yeo, Charles J.; Lillemoe, Keith D.; Roberts, John R.; Cameron, John L.

doi:10.1016/s0002-9610(99)80075-0

Cited by 54 publications

(39 citation statements)

References 28 publications

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“…27,30 Although reported figures are limited, times given for PSTD range between 217-360 min, 8,12,16 whilst those for PSDD range between 300-330 min. 19,21,23 Median blood loss of 1197 ml in this series was similar to that previously reported for PD (970 ml 27 ), PSTD (690 ml 16 ) and PSDD (1347 ml 19 ). Blood loss was noted to be greater among the malignant cases (1500m l) than the benign cases (700 ml), especially when concomitant partial colectomy was needed (2350 ml).…”

Section: Discussionsupporting

confidence: 88%

“…The operation can be considered for any benign neoplasm or ulceration of the distal duodenum, including Crohn's disease if medical treatment fails. 19 PSDD has also been described for patients with severe injuries of the distal duodenum. 19 Although villous adenomas at this site may be benign, larger neoplasms often contain foci of malignancy that can be missed on pre-operative biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…19 PSDD has also been described for patients with severe injuries of the distal duodenum. 19 Although villous adenomas at this site may be benign, larger neoplasms often contain foci of malignancy that can be missed on pre-operative biopsy. 31,32 Up to 40% of these lesions are carcinoma in situ 31;32 and thus potentially curable without a radical procedure.…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20][21][22][23][24] For neoplasms that arise in the third and fourth parts of the duodenum (D 3 , D 4 ), a conservative duodenectomy that preserves the pancreas and papilla can provide adequate tumour clearance while avoiding the additional dissection and risk associated with the biliary and pancreatic anastomoses implicit in the common alternative PD (or PSTD). Other advantages of this procedure include a shorter operative time and the preservation of more normal anatomy and function allowing postoperative endoscopic surveillance.…”

mentioning

confidence: 99%

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Pancreas-Sparing Distal Duodenectomy for Infrapapillary Neoplasms

Spalding

Isla

Thompson

et al. 2007

annals

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INTRODUCTION For neoplasms that arise in the third and fourth parts of the duodenum (D 3 , D 4 ), a duodenectomy that preserves the pancreas can provide adequate tumour clearance while avoiding the additional dissection and risk of the common alternative, pancreatoduodenectomy.PATIENTS AND METHODS Pancreas-sparing distal duodenectomy (PSDD) was performed in 14 patients with infrapapillary duodenal neoplasms between 1991-2002, and the clinical outcome is reviewed. The operation entails careful separation of the lower pancreatic head from D 3 , complete mobilisation of the ligament of Treitz and end-to-end duodenojejunal anastomosis 1-3 cm below the major duodenal papilla.RESULTS There were 9 men and 5 women of median age 56 years, who presented with iron-deficiency anaemia ( n = 8), gastric outlet obstruction ( n = 4), anaemia and gastric outlet obstruction ( n = 1), epigastric pain or mass (1 each). There were 11 malignant neoplasms (adenocarcinoma 5, stromal tumour 4, recurrent seminoma 1, plasmacytoma 1), 2 benign neoplasms (villous adenoma, lipoma) and 1 patient with steroid-induced ulceration. In addition to D 3 and D 4 , resection included the distal part of D 2 in 5 patients, while 4 required concomitant partial colectomy. Median operation time was 240 min and median blood loss 1197 ml, being greater for malignant than benign lesions (1500 ml versus 700 ml). There was one death from gangrenous cholecystitis, one early re-operation for anastomotic bleeding and one late re-operation for delayed gastric emptying secondary to anastomotic stricture, but no pancreatic complications. At a median follow-up of 47 months, three patients had died of recurrent disease while the other 10 were alive and well with no upper gastrointestinal symptoms.CONCLUSIONS Provided there is a minimum 1-cm clearance at the papilla, PSDD is a useful alternative to formal pancreatoduodenectomy in patients with unusual neoplasms arising from the third and fourth parts of the duodenum. Although a major undertaking in its own right, it avoids the extra time of a pancreatic resection and the extra risk of a pancreatic anastomosis.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pancreas-Sparing Distal Duodenectomy for Infrapapillary Neoplasms

Spalding

Isla

Thompson

et al. 2007

annals

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“…Tsiotos et al used the term PSD to mean almost complete resection of the duodenum (10). Meanwhile, Maher et al and we used PSD to describe resection of only the third and fourth portions of the duodenum (7,11). This procedure has also been named segmental duodenectomy (12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

Resection of the second portion of the duodenum sacrificing the minor papilla but preserving the pancreas for a recurrent duodenal adenocarcinoma: Report of a case

Yamashita

Sakamoto

Kaneko

et al. 2012

BST

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Pancreas-Sparing Duodenectomy for Duodenal Polyposis

Sarmiento

Thompson²,

Nagorney³

et al. 2002

Archives of Surgery

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Pancreas-sparing duodenectomy (PSD) is a safe and effective operative procedure for patients with nonmalignant duodenal polyps. Design: Retrospective analysis of outcomes in patients undergoing PSD. Setting: A tertiary referral center. Patients: All patients undergoing PSD at the Mayo Clinic, Rochester, Minn. Indications were the presence of numerous duodenal polyps or large, solitary, adenomatous polyps not amenable to endoscopic resection. Dysplasia without frank malignancy was demonstrated in all patients by endoscopic biopsy specimens. Follow-up was complete in all patients. Main Outcome Measures: Operative feasibility, shortand long-term complications, quality of life, and survival. Results: Five patients had diffuse polyposis (familial adenomatous polyposis) and 3 had very large periampullary villous adenomas. The mean age of the patients was 54 years (female-male ratio, 3:1). Colectomy preceded PSD in 5 patients (familial adenomatous polyposis); 3 had previous transduodenal excision of adenomas, and 2 had

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Pancreas-sparing duodenectomy for infra-ampullary duodenal pathology

Cited by 54 publications

References 28 publications

Pancreas-Sparing Distal Duodenectomy for Infrapapillary Neoplasms

Pancreas-Sparing Distal Duodenectomy for Infrapapillary Neoplasms

Resection of the second portion of the duodenum sacrificing the minor papilla but preserving the pancreas for a recurrent duodenal adenocarcinoma: Report of a case

Pancreas-Sparing Duodenectomy for Duodenal Polyposis

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