Pancreas-sparing duodenectomy for infra-ampullary duodenal pathology

Michael M. Maher, Charles J. Yeo, Keith D. Lillemoe, John R. Roberts, John L Cameron

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Surgical management of distal duodenal pathology is challenging because of the duodenum's retroperitoneal location and its shared blood supply with the pancreas. For infra-ampullary pathology, surgical treatment may include local excision, pancreaticoduodenectomy, or pancreas- sparing duodenectomy (PSD). PATIENTS AND METHODS: We retrospectively reviewed the management of 24 patients with infra-ampullary duodenal pathology treated by PSD between 1985 and 1994 at The Johns Hopkins Hospital. RESULTS: There were 16 men and 8 women with a mean age of 51.2 ± 4.4 years. The indications for elective PSD in 19 patients were neoplasms (n = 15), Crohn's disease (n = 2), and other (n = 2). Of the neoplasms, 13 were malignant (11 adenocarcinoma, 1 lymphoma, 1 liposarcoma) and 2 were benign (1 villous adenoma, 1 benign stromal tumor). Five patients had PSD as an emergency procedure for penetrating trauma. The mean follow-up is 24.2 ± 5.8 months (range 1 to 122). In the group undergoing elective PSD, the mean length of operation was 5.3 ± 0.4 hours, and the estimated blood loss was 569 ± 121 mL. In the entire series, there was 1 postoperative death from an anastomotic leak and 1 reexploration for anastomotic bleeding. Pancreas-sparing duodenectomy in patients with trauma or benign duodenal pathology resulted in a good outcome in all. In those 11 patients with duodenal adenocarcinoma, 7 have died, 2 have had recurrences, and 2 are disease free. Actuarial and disease-free, 2-year survival rates in the 11 patients with duodenal adenocarcinoma were 33% and 14%, respectively. CONCLUSIONS: Pancreas-sparing duodenectomy is a safe and effective treatment in patients with distal duodenal benign neoplasms or trauma, and PSD appears to have limited effectiveness for malignant distal duodenal pathology.

Original languageEnglish (US)
Pages (from-to)62-67
Number of pages6
JournalAmerican Journal of Surgery
Volume171
Issue number1
DOIs
StatePublished - Jan 1996

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Pancreas
Pathology
Adenocarcinoma
Neoplasms
Wounds and Injuries
Duodenal Neoplasms
Villous Adenoma
Liposarcoma
Anastomotic Leak
Pancreaticoduodenectomy
Duodenum
Crohn Disease
Lymphoma
Emergencies
Survival Rate
Hemorrhage
Recurrence
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Pancreas-sparing duodenectomy for infra-ampullary duodenal pathology. / Maher, Michael M.; Yeo, Charles J.; Lillemoe, Keith D.; Roberts, John R.; Cameron, John L.

In: American Journal of Surgery, Vol. 171, No. 1, 01.1996, p. 62-67.

Research output: Contribution to journalArticle

Maher, Michael M. ; Yeo, Charles J. ; Lillemoe, Keith D. ; Roberts, John R. ; Cameron, John L. / Pancreas-sparing duodenectomy for infra-ampullary duodenal pathology. In: American Journal of Surgery. 1996 ; Vol. 171, No. 1. pp. 62-67.
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