Pancreatico-duodenectomy for non-ampullary duodenal lesions: Indications and results

Abstract

Aims: Pancreaticoduodenectomy (PD) is a commonly performed procedure for patients with periampullary tumors. Although the rate of perioperative mortality and morbidity has significantly decreased over the past few decades, the incidence of local reccurence still remains high. In the majority of cases, local recurrences are considered non-resectable, but in selected cases completion pancreatectomy (CP) may be regarded as a curative option. However, this procedure is suitable for only a minor fraction of patients. In this small study we describe our experience in performing laparoscopic completion pancreatectomy (LCP) in two patients with a history of PD for periampullary malignant tumors. Methods: Two patients with recurrences of malignant tumors in the pancreatic remnant underwent LCP in our institution. The patient journals were retrospectively reviewed. The first patient was diagnosed a recurrence from the adenocarcinoma of the ampulla of Vater 3 years after initial PD. The second patient had previously undergone PD for metastases from renal cell carcinoma in the pancreatic head and now had a recurrence, detected in pancreatic remnant. Preoperative clinical characteristics, imaging studies, operation details, postoperative features and follow-up data were analyzed. Results: Despite of challenging anatomical alterations, both operations were carried out without major intraoperative unfavourable incidents. Although one of the patients was reoperated laparoscopically for haemorrhage on the first postoperative day, further postoperative course was uneventful. Conclusions: In this cases LCP was demonstrated to be a feasible and appropriate technique. Thus, LCP should be taken into consideration as an option in the surgical management for selected cases with recurrence in pancreatic remnant after initial PD. Aims: The management of metastatic Renal cell carcinoma (RCC) confers poor results with median 5-year survival 5e 20%. Surgery is a possible option for oligometastatic disease of the liver and pancreas. The aim of our study is to investigate the outcomes of the surgical management of these patients in our institution. Methods: This is a retrospective review of 13 patients who had liver or pancreatic resection for RCC metastasis in our institution over the last 11 years. Pancreatic metastasis was diagnosed at a median of 73 months (range: 9e292) after nephrectomy, while hepatic metastasis at a median of 29 months (range: 4e129). Results: Seven pancreatic (3 pancreaticoduodenectomies, 2 total pancreatectomies and 2 distal pancreatectomies) and 7 liver resections (1 right hepatectomy and 6 non-anatomical liver resections) were performed. The postoperative complication rate was 42.8% after pancreatic and 14.3% after liver resection. The median length of stay was 18 days (range: 8e28) after pancreatic and 9 days (range: 4e27) after liver resection. Seven patients developed subsequent metastatic disease (median time: 10 months, range: 3e54). The median disease free survival after pancreatic resection was 27 months (ran...