Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH.
Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH.
Surgery. 2018 Mar;163(3):594-599. doi: 10.1016/j.surg.2017.10.035. Epub 2018 Jan 10.
To review our experience in patients undergoing operative treatment for duodenal polypoisis associated with familial adenomatous polyposis with an emphasis on operative approach and long-term outcomes.
Duodenal polypoisis associated with familial adenomatous polyposis patients undergoing operative treatment were studied retrospectively excluding patients with preoperative duodenal cancer.
Of 767 patients in the database, 63 (8.2%) patients underwent operative treatment: 42 (67%) pancreas-sparing duodenectomy, 15 (24%) pancreatoduodenectomy, and 6 (9.5%) segmental duodenal resection; the majority for Spigelman stages III and IV polyposis. Overall 9.6% had adenocarcinoma postoperatively (28.6% in the pancreatoduodenectomy group; P = .01). The proportion of Spigelman stages III and IV with cancer were 9.5% and 6.5%, respectively. Pathologic upgrade to cancer in patients with low grade dysplasia and high-grade dysplasia on preoperative biopsy was 5.7% and 6.7%, respectively (P = .13). At a median follow-up of 16 years, 7.7% needed a second duodenal polypoisis associated with familial adenomatous polyposis-related operation. Progression to high grade dysplasia or cancer in the stomach occurred in 15.4% of patients. Median overall survival and recurrence-free survival was at least 16 years and 15.6 years. No significant group-based differences were noted on follow-up.
The majority of patients with duodenal polypoisis associated with familial adenomatous polyposis can achieve long-term, cancer-free survival with organ-preserving approaches (pancreas-sparing-duodenectomy and segmental-duodenal-resection) with survival not dependent on the type of resection.
回顾我们在家族性腺瘤性息肉病相关十二指肠息肉病患者中进行手术治疗的经验，重点介绍手术方法和长期结果。
回顾性研究数据库中接受手术治疗的家族性腺瘤性息肉病相关十二指肠息肉病患者，排除术前患有十二指肠癌的患者。
在数据库中的 767 名患者中，有 63 名（8.2%）接受了手术治疗：42 名（67%）行保留胰腺的十二指肠切除术，15 名（24%）行胰十二指肠切除术，6 名（9.5%）行节段性十二指肠切除术；大多数为 Spigelman 分期 III 和 IV 型息肉病。总体而言，术后有 9.6%的患者发生腺癌（胰十二指肠切除术组为 28.6%；P=0.01）。Spigelman 分期 III 和 IV 型的癌症比例分别为 9.5%和 6.5%。术前活检有低级别异型增生和高级别异型增生的患者中，病理升级为癌症的比例分别为 5.7%和 6.7%（P=0.13）。在中位随访 16 年时，有 7.7%的患者需要进行第二次与家族性腺瘤性息肉病相关的十二指肠息肉病手术。15.4%的患者胃发生高级别异型增生或癌症。总体生存和无复发生存的中位数至少为 16 年和 15.6 年。随访时未观察到组间存在显著差异。
大多数家族性腺瘤性息肉病相关十二指肠息肉病患者可以通过保留器官的方法（保留胰腺的十二指肠切除术和节段性十二指肠切除术）实现长期无癌症生存，且生存与切除类型无关。
