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Severe Duodenal Involvement in Familial Adenomatous Polyposis Treated by Pylorus-Preserving Pancreaticoduodenectomy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Pancreaticoduodenectomy is an alternative to pancreas-sparing duodenectomy for radical treatment of duodenal lesions. The aims of this study were to assess the results of pylorus-preserving pancreaticoduodenectomy (PPPD) for severe duodenal polyposis in familial adenomatous polyposis in terms of morbidity, long-term influence on functional results, the recurrence rate of cancer or jejunal polyps, and survival.

Methods

All patients operated on for a PPPD between 1992 and 2009 were included. Clinical data, endoscopic findings, and pathologic examinations were evaluated.

Results

A total of 19 patients underwent PPPD for severe duodenal polyposis (17 Spigelman IV, 1 Spigelman III, and 1 invasive carcinoma). Postoperative mortality was nil. The postoperative morbidity rate was 42%, including 4 pancreatic fistulae (21%) and 2 delayed gastric emptying (11%). Pathologic examination found 7 invasive carcinomas, of which only 1 was known before resection. One third of patients operated on without a preoperative diagnosis of malignancy already had an invasive duodenal carcinoma. After a mean follow-up of 58 months, 16 patients were alive. Thirteen patients underwent endoscopic follow-up, and new adenomas were found in 4 (31%). All were treated successfully during the same endoscopic procedure. PPPD did not modify the functional result after coloproctectomy.

Conclusions

PPPD remains a safe and efficient therapeutic option for severe duodenal polyposis in familial adenomatous polyposis patients.

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Authors and Affiliations

  1. Department of Digestive Surgery, Hôpital Saint Antoine, Paris, France

    Frédéric Caillié MD, François Paye MD, PhD, Malika Bennis MD, Jérémie H. Lefèvre MD, Yann Parc MD, PhD, Pierre Balladur MD, PhD & Emmanuel Tiret MD

  2. Department of Digestive Endoscopy, Hôpital Saint Antoine, Paris, France

    Benoit Desaint MD

  3. Department of Pathology, Hôpital Saint Antoine, Paris, France

    Magali Svrcek MD, PhD

  4. UPMC University Pierre et Marie Curie, Paris VI, France

    François Paye MD, PhD, Jérémie H. Lefèvre MD, Yann Parc MD, PhD, Pierre Balladur MD, PhD & Emmanuel Tiret MD

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  1. Frédéric Caillié MD
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  2. François Paye MD, PhD
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Correspondence to François Paye MD, PhD.

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Caillié, F., Paye, F., Desaint, B. et al. Severe Duodenal Involvement in Familial Adenomatous Polyposis Treated by Pylorus-Preserving Pancreaticoduodenectomy. Ann Surg Oncol 19, 2924–2931 (2012). https://doi.org/10.1245/s10434-012-2221-x

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