Ann Hepatobiliary Pancreat Surg.  2022 May;26(2):149-158. 10.14701/ahbps.21-124.

Pancreas-preserving limited duodenal resection: Minimizing morbidity without compromising oncological adequacy

Affiliations
  • 1Department of Surgical Gastroenterology, Mahatma Gandhi University of Medical Science and Technology, Jaipur, India
  • 2Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India

Abstract

Backgrounds/Aims
Pancreaticoduodenectomy is the most common procedure for the management of duodenal pathologies. However, it is associated with substantial morbidity and a low risk of mortality. Pancreas-preserving limited duodenal resection (PPLDR) can be performed under specific scenarios. We share our experience with PPLDR and its outcome.
Methods
We retrospectively analyzed a prospectively maintained database of patients undergoing limited duodenal resection in the form of wedge (sleeve) resection or segmental resection of one or more duodenal segments from March 2016 to March 2021 at a tertiary care center in North India.
Results
During the study period, 10 patients (including 9 males) underwent PPLDR. Five of these 10 patients showed primary duodenal or proximal jejunal pathology, while the remaining five had duodenal pathology involving an adjacent organ tumor. Four patients underwent wedge (sleeve) resection, while the remaining six underwent segmental duodenal resection of one or more duodenal segments. Mean hospital stay was 6 days (range, 3–11 days) without 30-day mortality. Morbidity occurred in 4 patients (Grade I–II, n = 3; Grade III, n = 1). All patients were alive and disease-free at the time of last follow-up. The mean follow-up duration was 23 months (range, 2–48 months).
Conclusions
PPLDR is a safe and effective alternative for pancreaticoduodenectomy when selected carefully for specific tumor types and location.

Keyword

Duodenal neoplasms; Pancreaticoduodenectomy

Figure

  • Fig. 1 Diagrammatic representation of surgical procedures. (A) Primary repair of a minor defect in duodenal wall. (B) Jejunal serosal (loop) patch repair of large defect in the duodenal wall. (C) End-toend duodenojejunostomy. (D) Side-to-side duodenojejunostomy.

  • Fig. 2 (A, B) Computed tomography image of primary jejunal adenocarcinoma (arrows). (C) Intra-operative image showing jejunal tumor after mobilization of duodeno-jejunal flexure. (D, E) Resected specimen showing jejunal tumor.

  • Fig. 3 (A, B) Computed tomography images of large retroperitoneal sarcoma. (C, D) Intra-operative image showing large retroperitoneal sarcoma with focal duodenal involvement (arrows).

  • Fig. 4 (A) Computed tomography (CT) image showing hepatic flexure growth with colo-duodenal fistula (arrow). (B) Coronal section of CT scan showing colo-duodenal fistula (arrow). (C) Intra-operative image showing duodenal involvement (specimen retracted by the first assistant). (D) Jejunal patch in progress (side-to-side loop). (E) Resected specimen showing hepatic flexure colonic growth with duodenal fistula.

  • Fig. 5 Algorithm for management of duodenal pathologies requiring pancreas-preserving limited duodenal resection (PPLDR).

  • Fig. 6 Intra-operative image showing completed side-to-side duodenojejunal anastomosis.


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