Pancreas-sparing duodenectomy for infra-ampullary duodenal pathology

Background Surgical management of distal duodenal pathology is challenging because of the duodenumʹs 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), Crohnʹs 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 diseasefree, 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.