Duodenal Villous Tumors

Bjork, Kevin J.; Davis, Chad; Nagorney, David M.; Mucha, Peter

doi:10.1001/archsurg.1990.01410200019001

Cited by 64 publications

(43 citation statements)

References 18 publications

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“…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. One patient in our series was free of recurrence 41 months after PSDD for a villous adenoma, and there is a reported case of similar success at 24 months.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

Pancreas-Sparing Distal Duodenectomy for Infrapapillary Neoplasms

Spalding

Isla

Thompson

et al. 2007

annals

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“…Like large bowel adenomas, they can be premalignant, with villous architecture, in creasing size, and atypia being markers of malignant progression. Up to one third of vil lous duodenal adenomas contain malignant invasive elements [24], Adenomas occur pre dominantly in the second part of the duode num, particularly in the periampullary region. Compared with colonic adenomas, duodenal adenomas have a greater percentage of vil lous-type architecture.…”

Section: Adenomasmentioning

confidence: 99%

Small Bowel Tumors: An Overview

O’Riordan

Vilor

Herrera

1996

Dig Dis

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“…To date, the data on EMR for duodenal neoplasms are limited [5][6][7]. The safety and efficacy of EMR for the treatment of nonampullary duodenal neoplasms, predominantly duodenal adenomas, was evaluated for patients who had no familial polyposis syndrome.…”

Section: Introductionmentioning

confidence: 99%