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Long-Term Outcomes of Pancreas-Sparing Duodenectomy for Duodenal Polyposis in Familial Adenomatous Polyposis Syndrome

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Pancreas-sparing duodenectomy (PSD) offers definitive therapy for duodenal polyposis associated with familial adenomatous polyposis (FAP). We reviewed the long-term complications of PSD and evaluated the incidence of high-grade dysplasia (HGD) and cancer in the remaining upper gastrointestinal tract.

Methods

Forty-seven FAP patients with duodenal polyposis undergoing PSD from 1992 to 2019 were reviewed. Long-term was defined as > 30 days from PSD.

Results

All patients were treated with an open technique, and 43 (91.5%) had Spigelman stage III or IV duodenal polyposis. Median follow-up was 107 months (IQR, 26–147). There was no 90-day mortality. Seven patients died at a median of 10.5 years (IQR, 5.4–13.3) after PSD, with one attributed to gastric cancer. Pancreatitis occurred in 10 patients (21.3%), and two required surgical intervention. Seven patients (14.9%) developed an incisional hernia, and all underwent definitive repair. Forty-one patients (87.2%) had postoperative surveillance endoscopy over a median follow-up of 111 months (IQR, 42–138). Three patients (6.4%) developed adenocarcinoma (two gastric, one jejunal), and four (8.5%) had adenomas with HGD (two gastric, two jejunal) with a median of 15 years (IQR, 9–16) from PSD. One patient with gastric adenocarcinoma and all patients with HGD or adenocarcinoma of the jejunum required surgical intervention.

Conclusion

PSD can be performed with a low but definable risk of long-term morbidity. Risk of gastric and jejunal carcinoma rarely occurs and was diagnosed decades after PSD. This demonstrates the need for lifelong endoscopic surveillance and educates us on the risk of carcinoma in the remaining gastrointestinal tract.

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Abbreviations

PSD:

Pancreas-sparing duodenectomy

FAP:

Familial adenomatous polyposis

APC:

Adenomatous polyposis coli

BMI:

Body mass index

SSI:

Surgical site infection

OSI:

Organ space infection

HGD:

High-grade dysplasia

LGD:

Low-grade dysplasia

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Authors and Affiliations

  1. Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA

    Robert Naples, Robert Simon, Maitham Moslim, Toms Augustin & R. Matthew Walsh

  2. Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA

    James Church & Matthew Kalady

  3. Sanford R. Weiss, MD, Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, OH, USA

    James Church, Carol A. Burke, Amit Bhatt, Matthew Kalady & R. Matthew Walsh

  4. Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA

    Carol A. Burke & Amit Bhatt

Authors
  1. Robert Naples
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  2. Robert Simon
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  3. Maitham Moslim
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  4. Toms Augustin
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  5. James Church
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  6. Carol A. Burke
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  7. Amit Bhatt
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  8. Matthew Kalady
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  9. R. Matthew Walsh
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Authors meet all 4 criteria for authorship as described by the International Committee of Medical Journal Editors (ICMJE).

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Correspondence to Robert Simon.

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Naples, R., Simon, R., Moslim, M. et al. Long-Term Outcomes of Pancreas-Sparing Duodenectomy for Duodenal Polyposis in Familial Adenomatous Polyposis Syndrome. J Gastrointest Surg 25, 1233–1240 (2021). https://doi.org/10.1007/s11605-020-04621-7

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  • DOI: https://doi.org/10.1007/s11605-020-04621-7

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