Pancreas sparing duodenectomy in the treatment of primary duodenal neoplasms and other situations with duodenal involvement.

Abstract

BACKGROUND\nThere are no clearly defined indications for pancreas-preserving duodenectomy. The present study aimed to analyze postoperative morbidity and the outcomes of patients undergoing pancreas-preserving duodenectomy.\n\n\nMETHODS\nPatients undergoing pancreas-preserving duodenectomy from April 2008 to May 2020 were included. We divided the series according to indication: scenario 1, primary duodenal tumors; scenario 2, tumors of another origin with duodenal involvement; and scenario 3, emergency duodenectomy.\n\n\nRESULTS\nWe included 35 patients. Total duodenectomy was performed in 1 patient of adenomatous duodenal polyposis, limited duodenectomy in 7, and third\xa0+\xa0fourth duodenal portion resection in 27. The indications for scenario 1 were gastrointestinal stromal tumor (n\xa0=\xa013), adenocarcinoma (n\xa0=\xa04), neuroendocrine tumor (n\xa0=\xa03), duodenal adenoma (n\xa0=\xa01), and adenomatous duodenal polyposis (n\xa0=\xa01); scenario 2: retroperitoneal desmoid tumor (n\xa0=\xa02), recurrence of liposarcoma (n\xa0=\xa02), retroperitoneal paraganglioma (n\xa0=\xa01), neuroendocrine tumor in pancreatic uncinate process (n\xa0=\xa01), and duodenal infiltration due to metastatic adenopathies of a germinal tumor with digestive hemorrhage (n\xa0=\xa01); and scenario 3: aortoenteric fistula (n\xa0=\xa03), duodenal trauma (n\xa0=\xa01), erosive duodenitis (n\xa0=\xa01), and biliopancreatic limb ischemia (n\xa0=\xa01). Severe complications (Clavien-Dindo ≥ IIIb) developed in 14% (5/35), and postoperative mortality was 3% (1/35).\n\n\nCONCLUSIONS\nPancreas-preserving duodenectomy is useful in the management of primary duodenal tumors, and is a technical option for some tumors with duodenal infiltration or in emergency interventions.