Surgical management for advanced duodenal adenomatosis and duodenal cancer in Dutch patients with familial adenomatous polyposis: A nationwide retrospective cohort study

Heumen, Bjorn W H van; Nieuwenhuis, Marry H.; Goor, Harry van; Mathus-Vliegen, Lisbeth; Dekker, Evelien; Gouma, Dirk J.; Dees, Jan; Eijck, Casper H.J. van; Vasen, Hans F. A.; Nagengast, Fokko M.

doi:10.1016/j.surg.2011.12.008

Cited by 53 publications

(57 citation statements)

References 40 publications

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“…This interesting association has already been noticed, leading the authors to recommend patients diagnosed with CRC at previous initial surgery to follow the recommended surveillance protocols (17).…”

Section: Discussionmentioning

confidence: 84%

“…In a survey among polyposis registries coordinated by the Leeds Castle Group, the mean age at the time of surgery for invasive carcinoma (53 years) was 10 years higher than that for severe polyposis (43 years) (20). Similarly, a nationwide study found mean ages of 53 years among a group of 18 duodenal cancers and 48 years in those with benign adenomatosis (17). In the present series, duodenal neoplasia was detected 15 years after FAP treatment, and advanced adenomatosis patients were also operated earlier than cancers (45.3 vs. 55.8 years, respectively).…”

Section: Discussionmentioning

confidence: 98%

“…In a retrospective multicenter study from Japan, Yamaguchi et al (6) reported 7 cases (2.8%) among 247 FAP patients. The Dutch Registry found 18 cases (1.7%) of duodenal cancer out of 1,066 patients during a 33-year period (17). Another important study registered a 1.9% incidence rate at the St Mark Hospital Polyposis Registry (15).…”

Section: Discussionmentioning

confidence: 99%

“…Timing and choice for surgery should take into account several features such as age and health status, previous abdominal surgery, severity and evolution of duodenal adenomatosis, previous treatments and staging (17). Such features may help decide between local (duodenotomy with polypectomy and/or ampullectomy) or more radical procedures (pancreas and pylorus sparing duodenectomy, cephalic pancreaticoduodenectomy).…”

Section: Discussionmentioning

confidence: 99%

“…As duodenal adenomas progress slowly to carcinoma (16), it is justified to develop aggressive and effective endoscopic surveillance programs to identify any precursor lesion (17). Local management of duodenal polyposis is associated with high rates of recurrence, although it may postpone cancer development.…”

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: 84%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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Survival outcomes after surgical management of sporadic or familial adenomatous polyposis associated duodenal cancer

Augustin

Moslim

Cengiz

et al. 2020

Journal of Surgical Oncology

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Background: Duodenal cancer is the second most common cause of cancer death in familial adenomatous polyposis (FAP) patients. In this study, we compare oncologic outcomes between sporadic and FAP-associated duodenal cancer. Methods: In this retrospective study, all patients who underwent surgeries between 2000 and 2014 for either sporadic or FAP duodenal cancer were identified. The patients were grouped based on diagnoses and perioperative and survival outcomes were compared. Results: A total of 56 patients with duodenal cancer (43 sporadic, 13 FAP) who underwent surgery were identified. Pancreatoduodenectomy (PD) was the most common procedure performed. The overall median survival was 7.5 years (1 year: 92%; 5 years: 58.1%). FAP patients had earlier tumor, node, and metastasis stage, less margin involvement, less perineural, and angiolymphatic invasion but had a comparable survival to sporadic patients. The median survival for FAP duodenal cancer was 7.4 vs 9.6 years for sporadic (P = .97) with similar utilization of adjuvant chemotherapy. Although not statistically significant, PD had an improved median survival compared to segmental duodenal resection (SDR) (9.6 years for PD vs 3.6 years for SDR, P = .17). Non-periampullary location and presence of positive lymph nodes were significant predictors of mortality on multivariate analysis. Conclusions: FAP duodenal cancer has no survival advantage compared to sporadic duodenal cancer despite an improved stage of resection with extraampullary lesions having a worse survival.

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Surgical management for advanced duodenal adenomatosis and duodenal cancer in Dutch patients with familial adenomatous polyposis: A nationwide retrospective cohort study

Cited by 53 publications

References 40 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

Survival outcomes after surgical management of sporadic or familial adenomatous polyposis associated duodenal cancer

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