Surgical approach for tumours of the third and fourth part of the duodenum. Distal pancreas-sparing duodenectomy

García‐Molina, Francisco; Mateo-Vallejo, Francisco; Franco-Osorio, Juan de Dios; Esteban-Ramos, Juan L.; Rivero-Henández, Iosvany

doi:10.1016/j.ijsu.2015.04.051

Cited by 25 publications

(16 citation statements)

References 26 publications

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“…To the knowledge of the authors, this series brings to 83 the total number of patients undergoing PPDD that have been reported in published literature, which comprises 4 other series and 10 reports of individual cases[3,8,9,12-22]. These are summarized in Table 3.…”

Section: Discussionmentioning

confidence: 99%

Pancreas preserving distal duodenectomy: A versatile operation for a range of infra-papillary pathologies

Mitchell¹,

Thomas²,

Zaitoun³

et al. 2017

WJG

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AIMTo investigate the range of pathologies treated by pancreas preserving distal duodenectomy (PPDD) and present the outcome of follow-up.METHODSNeoplastic lesions of the duodenum are treated conventionally by pancreaticoduodenectomy. Lesions distal to the major papilla may be suitable for a pancreas-preserving distal duodenectomy, potentially reducing morbidity and mortality. We present our experience with this procedure. Selective intraoperative duodenoscopy assessed the relationship of the papilla to the lesion. After duodenal mobilisation and confirmation of the site of the lesion, the duodenum was transected distal to the papilla and beyond the duodenojejunal flexure and a side-to-side duodeno-jejunal anastomosis was formed. Patients were identified from a prospectively maintained database and outcomes determined from digital health records with a dataset including demographics, co-morbidities, mode of presentation, preoperative imaging and assessment, nutritional support needs, technical operative details, blood transfusion requirements, length of stay, pathology including lymph node yield and lymph node involvement, length of follow-up, complications and outcomes. Related published literature was also reviewed.RESULTSTwenty-four patients had surgery with the intent of performing PPDD from 2003 to 2016. Nineteen underwent PPDD successfully. Two patients planned for PPDD proceeded to formal pancreaticoduodenectomy (PD) while three had unresectable disease. Median post-operative follow-up was 32 mo. Pathologies resected included duodenal adenocarcinoma (n = 6), adenomas (n = 5), gastrointestinal stromal tumours (n = 4) and lipoma, bleeding duodenal diverticulum, locally advanced colonic adenocarcinoma and extrinsic compression (n = 1 each). Median postoperative length of stay (LOS) was 8 d and morbidity was low [pain and nausea/vomiting (n = 2), anastomotic stricture (n = 1), pneumonia (n = 1), and overwhelming post-splenectomy sepsis (n = 1, asplenic patient)]. PPDD was associated with a significantly shorter LOS than a contemporaneous PD series [PPDD 8 (6-14) d vs PD 11 (10-16) d, median (IQR), P = 0.026]. The 30-d mortality was zero and 16 of 19 patients are alive to date. One patient died of recurrent duodenal adenocarcinoma 18 mo postoperatively and two died of unrelated disease (at 2 mo and at 8 years respectively).CONCLUSIONPPDD is a versatile operation that can provide definitive treatment for a range of duodenal pathologies including adenocarcinoma.

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Section: Discussionmentioning

confidence: 99%

Pancreas preserving distal duodenectomy: A versatile operation for a range of infra-papillary pathologies

Mitchell¹,

Thomas²,

Zaitoun³

et al. 2017

WJG

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“…It is caused by germline mutations in BRAF V600E, RAS family or succinate dehydrogenase subunits (SDH A-D). GISTs in NF1 are usually wild type with possible implication of RAS-MAPK pathway (104,(117)(118)(119). This subset of GISTs is relatively resistant to the treatment with imatinib.…”

Section: Histopathology and Molecular Characteristicsmentioning

confidence: 99%

“…Although in most cases wedge and segmental resections could be relatively straightforward, severe complications may occur such as acute pancreatitis, pancreatic fistula, significant blood loss and anastomotic stenosis (117,118). Delayed gastric emptying treating with gastrojejunostomy and the fearsome anastomotic failure necessitated secondary PD (101) and injury of the mesenteric root managed by total enterectomy have been described in the literature (132).…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…Delayed gastric emptying treating with gastrojejunostomy and the fearsome anastomotic failure necessitated secondary PD (101) and injury of the mesenteric root managed by total enterectomy have been described in the literature (132). The pitfalls in segmental resections are associated with the superior mesenteric vessels lying on the third portion, adjacent pancreas and the common blood supply, necessity to preserve ampulla Vateri (117,107).…”

Section: Surgical Treatmentmentioning

confidence: 99%

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Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review

Popivanov¹,

Tabakov²,

Mantese³

et al. 2018

Transl. Gastroenterol. Hepatol

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Background: Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumours in the digestive tract. The duodenal GIST (dGIST) is the rarest subtype, representing only 4-5% of all GIST, but up to 21% of the resected ones. The diagnostic and therapeutic management of dGIST may be difficult due to the rarity of this tumor, its anatomical location, and the clinical behavior that often mimic a variety of conditions; moreover, there is lack of consent for their treatment. This study has evaluated the scientific literature to provide consensus on the diagnosis of dGIST and to outline possible options for surgical treatment.Methods: An extensive research has been carried out on the electronic databases MEDLINE, Scopus, EMBASE and Cochrane to identify all clinical trials that report an event or case series of dGIST.Results: Eighty-six studies that met the inclusion criteria were identified with five hundred forty-nine patients with dGIST: twenty-seven patients were treated with pancreatoduodenectomy and ninety-six with only local resection (segmental/wedge resections); in four hundred twenty-six patients it is not possible identify the type of treatment performed (pancreatoduodenectomy or segmental/wedge resections).Conclusions: dGISTs are a very rare subset of GISTs. They may be asymptomatic or may involve symptoms of upper GI bleeding and abdominal pain at presentation. Because of the misleading clinical presentation the differential diagnosis may be difficult. Tumours smaller than 2 cm have a low biological aggressiveness and can be followed annually by endoscopic ultrasound. The biggest ones should undergo radical surgical resection (R0). In dGIST there is no uniformly adopted surgical strategy because of the low incidence, lack of experience, and the complex anatomy of the duodenum. Therefore, individually tailored surgical approach is recommended. R0 resection with 1-2 cm clear margin is required. Lymph node dissection is not recommended due to the low incidence of lymphatic metastases. Tumor rupture should be avoided.

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“…Duodenum is the most affected part of the small bowel with cancer (2). However, cancer involving the third or fourth part of the duodenum has its unique challenges in its diagnosis and management due to its complex anatomical location (3). We reported this rare case of a young male with adenocarcinoma in the third part of the duodenum and reviewed the relative literature.…”

Section: Introductionmentioning

confidence: 99%

Small bowel adenocarcinoma in a young male: a case report

Almajid¹,

Tanveer²,

Alamri³

et al. 2019

Electron. physician

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Introduction: Adenocarcinoma of the third part of the duodenum is a rare type of tumor that has challenges in its diagnosis and management. Segmental resection with pancreatic sparing is a safe and accepted choice for the surgical intervention of this type of cancer. Case Presentation: A 33-year-old male presented with a 3-week history of symptoms of gastric outlet obstruction with anemia and weight loss. Upon investigating the patient with computed tomography and esophagogastroduodenoscopy, he was found to have an adenocarcinoma that involved the third part of the duodenum. The patient underwent segmental resection of the third and fourth part of the duodenum with pancreatic sparing. He had a smooth postoperative course. The pathological evaluation shows a 3 cm moderately differentiated adenocarcinoma with free margins. Six out of thirteen lymph nodes were having metastasis. The patient developed a soft tissue recurrence 18 months after the operation. Takeaway Lessons: Adenocarcinoma of the third part of the duodenum should be kept in mind in any patient presented with symptoms of gastric outlet obstruction. It can be managed safely with segmental resection avoiding the morbidity of resection of the pancreas. Keywords: Adenocarcinoma of the small bowel, third part of the duodenum, segmental resection Note: This case report is prepared using the CARE Checklist (2013) of information to include when writing a case report (https://www.care-statement.org). The CARE guidelines for case reports help reduce bias, increase transparency, and provide early signals of what works, for which patients, and under which circumstance.

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Surgical approach for tumours of the third and fourth part of the duodenum. Distal pancreas-sparing duodenectomy

Cited by 25 publications

References 26 publications

Pancreas preserving distal duodenectomy: A versatile operation for a range of infra-papillary pathologies

Pancreas preserving distal duodenectomy: A versatile operation for a range of infra-papillary pathologies

Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review

Small bowel adenocarcinoma in a young male: a case report

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