Pancreaticoduodenectomy for advanced duodenal and ampullary adenomatosis in familial adenomatous polyposis

Skipworth, James; Morkane, Clare; Raptis, Dimitri Aristotle; Vyas, Soumil; Damink, Steven W. M. Olde; Imber, Charles; Pereira, Stephen P.; Malagó, Massimo; West, Nicholas J.; Phillips, R. K. S.; Clark, Sue; Shankar, Arjun

doi:10.1111/j.1477-2574.2011.00292.x

Cited by 34 publications

(39 citation statements)

References 62 publications

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“…In this context, the Spigelman score has been widely adopted to guide surveillance frequency after 25-30 years of age, as well as to help with the therapeutic decisions process (6). However, the identification of patients at risk remains a challenge, cause the progression between stages varies a lot (1,32). In this sense, avoidance of progression to stage IV disease would lessen duodenal cancer risk, and that is the reason why screening for duodenal carcinoma has been currently recommended.…”

Section: Discussionmentioning

confidence: 99%

“…In spite of this, a surgical approach in this situation may raise some controversy and cause duodenal resection presented significant morbidity (1).…”

Section: Discussionmentioning

confidence: 99%

“…Potential candidates should receive proper information and complete preoperative evaluation to assess surgical risks factors (1). In this setting, staging with computed tomography and EUS is crucial.…”

Section: Discussionmentioning

confidence: 99%

“…Throughout time, the early names of this syndrome (familial polyposis coli, familial adenomatosis coli) didn't recognize the importance of other extracolonic manifestations such as duodenal adenomatosis (1).…”

Section: Introductionmentioning

confidence: 99%

“…Local management of duodenal polyposis is associated with high rates of recurrence, although it may postpone cancer development. Thus, endoscopic or surgical management of patients diagnosed with large polyps, high-grade dysplasia or severe duodenal polyposis turned to be important preventive tools to decrease cancer deaths in FAP patients (1,18). Otherwise, patients diagnosed with duodenal cancer should undergo radical pancreaticoduodenectomy that may carry substantial morbidity and mortality rates (19,20).…”

Section: Introductionmentioning

confidence: 99%

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Advanced duodenal neoplasia and carcinoma in familial adenomatous polyposis: outcomes of surgical management

Campos

Bustamante-Lopez

Kanno

et al. 2017

J. Gastrointest. Oncol.

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Background: In addition to the presence of neoplasia in the colon and rectum, patients with familial adenomatous polyposis (FAP) may develop numerous polyps and carcinoma within the upper gastrointestinal tract. Methods:The aim of the present paper was to review the incidence advanced duodenal polyposis or cancer and their surgical outcomes. A retrospective review of patients' records from our department was performed. respectively. Duodenal carcinomas occurred later (55.8 years) when compared to advanced adenomatosis (45.3 years). Three patients were diagnosed due to symptoms, while the others were detected under endoscopic surveillance. Age interval between FAP treatment and duodenal neoplasia diagnosis was 15.3 years . All but one patient underwent duodenopancreatectomy (DP). Two from the 7 patients undergoing DP died, one from pulmonary embolism 30 days after surgery and the other from recurrent T4N0 duodenal tumor. Thus, major operative morbidity and mortality were 12.5%. Conclusions:In this single-center Brazilian series of FAP patients: (I) advanced duodenal neoplasia or cancer requiring surgery occurred in 5.5% of patients; (II) when reaching the fifth decade of life, patients should be carefully evaluated to diagnose and treat early lesions; (III) in spite of the technical complexity of DP, operative morbidity is acceptable in experienced hands; and (IV) continuous surveillance is necessary during follow-up.

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Section: Discussionmentioning

confidence: 99%

“…In spite of this, a surgical approach in this situation may raise some controversy and cause duodenal resection presented significant morbidity (1).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Advanced duodenal neoplasia and carcinoma in familial adenomatous polyposis: outcomes of surgical management

Campos

Bustamante-Lopez

Kanno

et al. 2017

J. Gastrointest. Oncol.

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Efficacy of endoscopic retrograde cholangiopancreatography in familial adenomatous polyposis patients after duodenectomy

et al. 2022

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Objectives Familial adenomatous polyposis (FAP) patients with Spigelman stage IV polyposis should be considered for prophylactic duodenectomy. Post‐surgical pancreaticobiliary complications occur and may require management via endoscopic retrograde cholangiopancreatography (ERCP). We aimed to assess the success and adverse events of ERCP in FAP patients after pancreas‐sparing duodenectomy (PSD) and pancreaticoduodenectomy (PD). Methods A retrospective review of FAP patients who underwent ERCP after PSD or PD from 1992 to 2020 at a quaternary referral center was completed. The technical success of ERCP was defined as the ability to identify the anastomosis and cannulate the duct. Post‐procedural adverse events were defined by bleeding, perforation, pancreatitis, or cholangitis. Clinical outcomes included the need for surgical intervention and recurrent pancreatitis after ERCP were assessed. Results Of 84 FAP patients with duodenectomy, 12 patients with PSD and two patients with PD underwent 17 ERCPs for pancreatic indications and five for biliary indications. The technical success of ERCP in patients with PSD and a single neoampullary complex for pancreatic ( n = 6) and biliary ( n = 5) indications was 100% but for those with PD ( n = 2) or PSD reconstruction with pancreatic divisum or separate anastomoses ( n = 3), it was 0%. Surgical intervention was required in 50% of patients with technically failed ERCP after PSD (2/4) and PD (1/2). There were no adverse events. Conclusions ERCP is expected to be therapeutically successful for biliary complications following PSD. Assessment and potential therapy for pancreatitis post‐PSD are best in the setting of a single neo‐ampullary complex rather than in PD or PSD with pancreatic divisum.

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Endoscopic management of duodenal adenomatosis in familial adenomatous polyposis—A case‐based review

et al. 2021

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Adenomatous polyposis (AP) diseases, including familial adenomatous polyposis (FAP), attenuated FAP (AFAP), and MUTYH-associated polyposis (MAP), are the second most common hereditary causes of colorectal cancer. A frequent extracolonic manifestation of AP disease is duodenal polyposis, which may lead to duodenal cancer in up to 18% of AP patients. Endoscopic surveillance is recommended at 0.5-to 5-year intervals depending on the extent of polyp growth and histological progression. Although the Spigelman classification is traditionally used to determine surveillance intervals, it lacks information on the (peri-) ampullary site, where 50% of duodenal carcinomas are located. Hence, information on the papilla has recently been added as a prognostic marker. Patients with duodenal adenoma(s) ≥10 mm and ampullary adenomas of any size are suggested to be referred to an expert center for endoscopic therapy, particularly endoscopic mucosal resection and endoscopic ampullectomy. Nonetheless, despite the logic of this approach, the long-term efficacy of endoscopic therapy is still to be demonstrated.

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Pancreaticoduodenectomy for advanced duodenal and ampullary adenomatosis in familial adenomatous polyposis

Abstract: Pancreaticoduodenectomy in FAP is associated with significant morbidity, but low mortality. All patients under consideration for operative intervention require careful preoperative counselling and optimization.

Cited by 34 publications

References 62 publications

Advanced duodenal neoplasia and carcinoma in familial adenomatous polyposis: outcomes of surgical management

Advanced duodenal neoplasia and carcinoma in familial adenomatous polyposis: outcomes of surgical management

Efficacy of endoscopic retrograde cholangiopancreatography in familial adenomatous polyposis patients after duodenectomy

Endoscopic management of duodenal adenomatosis in familial adenomatous polyposis—A case‐based review

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