Treatment Strategy of Pancreas‐Sparing Distal Duodenectomy for Distal Duodenal Malignancies with Adjustable Dissection Levels According to Disease Progression (with Video)

Abstract

Background Pancreas‐sparing distal duodenectomy (PSDD) is a favorable option for distal duodenal neoplasms, and its procedure, including the extent of lymphadenectomy, should be modified according to the malignancy of the tumor. However, there are no coherent reports on the details of this procedure or long‐term outcomes after each resection. Methods This study included 24 patients who underwent PSDD at our institution between January 2009 and October 2020. Patients were divided into two groups according to the tumor progression: nine with (Lv‐II) and fifteen without (Lv‐I) mesopancreas dissection. Postoperative outcomes were compared between the two groups. Results Two groups had similar operation times, blood loss, hospital stay, and the rate of delayed gastric emptying (DGE): 40% versus 44%. There were no Clavien–Dindo classification ≥ III complications in the Lv‐II group. The Lv‐II group had a larger number of examined lymph nodes (median: 29), and three (33%) patients had lymph node metastasis. No local recurrence was observed, although two patients in the Lv‐II group had liver metastasis. The 5‐year overall survival rates of the Lv‐I and Lv‐II groups were 100% and 78%, respectively. None of the patients had an impaired nutrition status after one year of surgery, and no rehospitalization was observed in either group. Conclusion Although PSDD with or without mesopancreas dissection entailed a high risk of DGE, this procedure showed favorable long‐term outcomes and may be an alternative to pancreatoduodenectomy in patients with distal duodenal neoplasms.