Skip to main content
SpringerLink
Log in

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

  • Original Scientific Report with Video
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Onkendi EO, Boostrom SY, Sarr MG et al (2012) 15-year experience with surgical treatment of duodenal carcinoma: a comparison of periampullary and extra-ampullary duodenal carcinomas. J Gastrointest Surg 16:682–691

    Article  PubMed  Google Scholar 

  2. Solaini L, Jamieson NB, Metcalfe M et al (2015) Outcome after surgical resection for duodenal adenocarcinoma in the UK. Br J Surg 102:676–681

    Article  CAS  PubMed  Google Scholar 

  3. Kato T, Ono Y, Oba A et al (2023) Comparison of the clinical efficacy of a new prognostic stratification for duodenal adenocarcinoma with that of TNM staging: the importance of T status with regard to the prognosis. Eur J Surg Oncol 49:122

    Article  PubMed  Google Scholar 

  4. Sato T, Color atlas of applied anatomy of lymphatics (1997) Nankodo, Japan

  5. Meijer LL, Alberga AJ, de Bakker JK et al (2018) Outcomes and treatment options for duodenal adenocarcinoma: a systematic review and meta-analysis. Ann Surg Oncol 25:2681–2692

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sakamoto T, Saiura A, Ono Y et al (2017) Optimal lymphadenectomy for duodenal adenocarcinoma: does the number alone matter? Ann Surg Oncol 24:3368–3375

    Article  PubMed  Google Scholar 

  7. Ito R, Mise Y, Takahashi Y et al (2022) Segmental resection with partial mesopancreatic and mesojejunal excision (pMME) for duodenal carcinoma of the third or fourth portion. Langenbecks Arch Surg 407:2143

    Article  PubMed  Google Scholar 

  8. Inoue Y, Saiura A, Yoshioka R et al (2015) Pancreatoduodenectomy with systematic mesopancreas dissection using a supracolic anterior artery-first approach. Ann Surg 262:1092–1101

    Article  PubMed  Google Scholar 

  9. Yi S, Nagakawa Y, Ren K et al (2020) The mesopancreas and pancreatic head plexus: morphological, developmental, and clinical perspectives. Surg Radiol Anat 42:1501–1508

    Article  PubMed  Google Scholar 

  10. Matsuda N, Hirose T, Kakushima N et al (2022) Comparison of endoscopic ultrasonography and conventional endoscopy for prediction of tumor depth in superficial nonampullary duodenal epithelial tumors. Digestion 103:319–328

    Article  CAS  PubMed  Google Scholar 

  11. Sanjay P, Takaori K, Govil S et al (2012) “Artery-first” approaches to pancreatoduodenectomy. Br J Surg 99:1027–1035

    Article  CAS  PubMed  Google Scholar 

  12. Nagakawa Y, Hosokawa Y, Sahara Y et al (2018) Approaching the superior mesenteric artery from the right side using the proximal-dorsal jejunal vein preisolation method during laparoscopic pancreaticoduodenectomy. Surg Endosc 32:4044–4051

    Article  PubMed  Google Scholar 

  13. Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International study group of pancreatic surgery (ISGPS). Surgery 142:761–768

    Article  PubMed  Google Scholar 

  14. Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the international study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161:584–591

    Article  PubMed  Google Scholar 

  15. Teoule P, Bartel F, Birgin E et al (2019) The Clavien-Dindo classification in pancreatic surgery: a clinical and economic validation. J Investig Surg 32:314–320

    Article  Google Scholar 

  16. Brown JA, Zenati MS, Simmons RL et al (2020) Long-term surgical complications after pancreatoduodenectomy: incidence, outcomes, and risk factors. J Gastrointest Surg 24:1581–1589

    Article  PubMed  Google Scholar 

  17. Kaklamanos IG, Bathe OF, Franceschi D et al (2000) Extent of resection in the management of duodenal adenocarcinoma. Am J Surg 179:37–41

    Article  CAS  PubMed  Google Scholar 

  18. Platoff RM, Kellish AS, Hakim A et al (2021) Simple versus radical resection for duodenal adenocarcinoma: a propensity score matched analysis of national cancer database. Am Surg 87:266–275

    Article  PubMed  Google Scholar 

  19. Chung RS, Church JM, vanStolk R (1995) Pancreas-sparing duodenectomy: indications, surgical technique, and results. Surgery 117:254–259

    Article  CAS  PubMed  Google Scholar 

  20. Spalding DR, Isla AM, Thompson JN et al (2007) Pancreas-sparing distal duodenectomy for infrapapillary neoplasms. Ann R Coll Surg Engl 89:130–135

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Kawano N, Ryu M, Kinoshita T et al (1995) Segmental resection of the duodenum for treating leiomyosarcoma associated with von Recklinghausen’s disease: a case report. Jpn J Clin Oncol 25:109–112

    CAS  PubMed  Google Scholar 

  22. Sohn TA, Lillemoe KD, Cameron JL et al (1998) Adenocarcinoma of the duodenum: factors influencing long-term survival. J Gastrointest Surg 2:79–87

    Article  CAS  PubMed  Google Scholar 

  23. Bakaeen FG, Murr MM, Sarr MG et al. (2000) What prognostic factors are important in duodenal adenocarcinoma? Arch Surg 135:635–641, Discussion 641–632

  24. Kato M, Nakajima K, Nishida T et al (2011) Local resection by combined laparoendoscopic surgery for duodenal gastrointestinal stromal tumor. Diagn Ther Endosc 2011:645609

    Article  PubMed  PubMed Central  Google Scholar 

  25. Maher MM, Yeo CJ, Lillemoe KD et al (1996) Pancreas-sparing duodenectomy for infra-ampullary duodenal pathology. Am J Surg 171:62–67

    Article  CAS  PubMed  Google Scholar 

  26. Chok AY, Koh YX, Ow MY et al (2014) A systematic review and meta-analysis comparing pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal stromal tumors. Ann Surg Oncol 21:3429–3438

    Article  PubMed  Google Scholar 

  27. Goh BK, Chow PK, Chok AY et al (2010) Impact of the introduction of laparoscopic wedge resection as a surgical option for suspected small/medium-sized gastrointestinal stromal tumors of the stomach on perioperative and oncologic outcomes. World J Surg 34:1847–1852.

    Article  PubMed  Google Scholar 

  28. Tocchi A, Mazzoni G, Puma F et al (2003) Adenocarcinoma of the third and fourth portions of the duodenum: results of surgical treatment. Arch Surg 138:80–85

    Article  PubMed  Google Scholar 

  29. Nakao A (2016) The mesenteric approach in pancreatoduodenectomy. Dig Surg 33:308–313

    Article  PubMed  Google Scholar 

  30. Schuh F, Mihaljevic AL, Probst P et al (2021) A simple classification of pancreatic duct size and texture predicts postoperative pancreatic fistula: a classification of the international study group of pancreatic surgery (ISGPS). Ann Surg 277:e597

    Article  PubMed  Google Scholar 

  31. Garcia-Molina FJ, Mateo-Vallejo F, Franco-Osorio Jde D et al (2015) Surgical approach for tumours of the third and fourth part of the duodenum. Distal pancreas-sparing duodenectomy. Int J Surg 18:143–148

    Article  PubMed  Google Scholar 

  32. Scholten L, Mungroop TH, Haijtink SAL et al (2018) New-onset diabetes after pancreatoduodenectomy: a systematic review and meta-analysis. Surgery 164:6

    Article  Google Scholar 

  33. Pancreatric Section BSoG, Pancreatic Society of Great B, Ireland et al. (2005) Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas. Gut 54 Suppl 5:v1–16

  34. Butler JR, Rogers T, Eckart G et al (2015) Is antisecretory therapy after pancreatoduodenectomy necessary? Meta-analysis and contemporary practices of pancreatic surgeons. J Gastrointest Surg 19:604–612

    Article  PubMed  Google Scholar 

  35. Kim H, Yoon YS, Han Y et al (2020) Effects of pancreatic enzyme replacement therapy on body weight and nutritional assessments after pancreatoduodenectomy in a randomized trial. Clin Gastroenterol Hepatol 18(926–934):e924

    Google Scholar 

  36. Nunobe S, Ri M, Yamazaki K et al (2021) Safety and feasibility of laparoscopic and endoscopic cooperative surgery for duodenal neoplasm: a retrospective multicenter study. Endoscopy 53:1065–1068

    Article  PubMed  Google Scholar 

  37. Murata Y, Tanemura A, Kato H et al (2017) Superiority of stapled side-to-side gastrojejunostomy over conventional hand-sewn end-to-side gastrojejunostomy for reducing the risk of primary delayed gastric emptying after subtotal stomach-preserving pancreaticoduodenectomy. Surg Today 47:1007–1017

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sakamoto Y, Yamamoto Y, Hata S et al (2011) Analysis of risk factors for delayed gastric emptying (DGE) after 387 pancreaticoduodenectomies with usage of 70 stapled reconstructions. J Gastrointest Surg 15:1789–1797

    Article  PubMed  Google Scholar 

  39. Yeo CJ, Barry MK, Sauter PK, et al. (1993) Erythromycin accelerates gastric emptying after pancreaticoduodenectomy. A prospective, randomized, placebo-controlled trial. Ann Surg 218:229–237, Discussion 237–228

  40. Cameron JL, Riall TS, Coleman J et al (2006) One thousand consecutive pancreaticoduodenectomies. Ann Surg 244:10–15

    Article  PubMed  PubMed Central  Google Scholar 

  41. Hashimoto Y, Traverso LW (2010) Incidence of pancreatic anastomotic failure and delayed gastric emptying after pancreatoduodenectomy in 507 consecutive patients: use of a web-based calculator to improve homogeneity of definition. Surgery 147:503–515

    Article  PubMed  Google Scholar 

  42. Mitchell WK, Thomas PF, Zaitoun AM et al (2017) Pancreas preserving distal duodenectomy: a versatile operation for a range of infra-papillary pathologies. World J Gastroenterol 23:4252–4261

    Article  PubMed  PubMed Central  Google Scholar 

  43. Itani KM, Coleman RE, Meyers WC et al (1986) Pylorus-preserving pancreatoduodenectomy. A clinical and physiologic appraisal. Ann Surg 204:655–664

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Tanaka M, Sarr MG (1988) Role of the duodenum in the control of canine gastrointestinal motility. Gastroenterology 94:622–629

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The authors received no funding for this work.

Author information

Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3–8–31 Ariake, Koto-ku, Tokyo, 135–8550, Japan

    Tomotaka Kato, Yoshihiro Ono, Atsushi Oba, Takafumi Sato, Hiromichi Ito, Yosuke Inoue & Yu Takahashi

  2. Department of Hepatobiliary-Pancreatic Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan

    Akio Saiura

Authors
  1. Tomotaka Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshihiro Ono
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Atsushi Oba
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takafumi Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiromichi Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yosuke Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akio Saiura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yu Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Yoshihiro Ono or Yu Takahashi.

Ethics declarations

Conflict of interest

There are no conflicts of interests for any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (TIFF 6596 KB)

Supplementary file2 (DOCX 18 KB)

Supplementary file3 (MOV 124193 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kato, T., Ono, Y., Oba, A. et al. Treatment Strategy of Pancreas-Sparing Distal Duodenectomy for Distal Duodenal Malignancies with Adjustable Dissection Levels According to Disease Progression (with Video). World J Surg 47, 1752–1761 (2023). https://doi.org/10.1007/s00268-023-06981-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-023-06981-y

Search

Navigation