Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona University, L'Hospitalet de Llobregat, Barcelona 08907, Spain.
Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona University, L'Hospitalet de Llobregat, Barcelona 08907, Spain.
Hepatobiliary Pancreat Dis Int. 2021 Oct;20(5):485-492. doi: 10.1016/j.hbpd.2021.02.007. Epub 2021 Mar 9.
There are no clearly defined indications for pancreas-preserving duodenectomy. The present study aimed to analyze postoperative morbidity and the outcomes of patients undergoing pancreas-preserving duodenectomy.
Patients undergoing pancreas-preserving duodenectomy from April 2008 to May 2020 were included. We divided the series according to indication: scenario 1, primary duodenal tumors; scenario 2, tumors of another origin with duodenal involvement; and scenario 3, emergency duodenectomy.
We included 35 patients. Total duodenectomy was performed in 1 patient of adenomatous duodenal polyposis, limited duodenectomy in 7, and third + fourth duodenal portion resection in 27. The indications for scenario 1 were gastrointestinal stromal tumor (n = 13), adenocarcinoma (n = 4), neuroendocrine tumor (n = 3), duodenal adenoma (n = 1), and adenomatous duodenal polyposis (n = 1); scenario 2: retroperitoneal desmoid tumor (n = 2), recurrence of liposarcoma (n = 2), retroperitoneal paraganglioma (n = 1), neuroendocrine tumor in pancreatic uncinate process (n = 1), and duodenal infiltration due to metastatic adenopathies of a germinal tumor with digestive hemorrhage (n = 1); and scenario 3: aortoenteric fistula (n = 3), duodenal trauma (n = 1), erosive duodenitis (n = 1), and biliopancreatic limb ischemia (n = 1). Severe complications (Clavien-Dindo ≥ IIIb) developed in 14% (5/35), and postoperative mortality was 3% (1/35).
Pancreas-preserving duodenectomy is useful in the management of primary duodenal tumors, and is a technical option for some tumors with duodenal infiltration or in emergency interventions.
保留胰腺的十二指肠切除术没有明确的适应证。本研究旨在分析行保留胰腺的十二指肠切除术患者的术后发病率和结局。
纳入 2008 年 4 月至 2020 年 5 月行保留胰腺的十二指肠切除术的患者。我们根据适应证将该系列分为以下情况：1 场景，原发性十二指肠肿瘤；2 场景，有十二指肠受累的其他来源肿瘤；3 场景，急诊十二指肠切除术。
共纳入 35 例患者。1 例患者因腺瘤性十二指肠息肉行全十二指肠切除术，7 例行局限性十二指肠切除术，27 例行第三+第四段十二指肠切除术。1 场景的适应证为胃肠道间质瘤（n=13）、腺癌（n=4）、神经内分泌肿瘤（n=3）、十二指肠腺瘤（n=1）和腺瘤性十二指肠息肉（n=1）；2 场景：腹膜后硬纤维瘤（n=2）、脂肪肉瘤复发（n=2）、腹膜后副神经节瘤（n=1）、胰钩突神经内分泌肿瘤（n=1）和生殖细胞肿瘤引起的转移性淋巴结病合并消化道出血导致的十二指肠浸润（n=1）；3 场景：主动脉肠瘘（n=3）、十二指肠创伤（n=1）、侵蚀性十二指肠炎（n=1）和胰胆支缺血（n=1）。严重并发症（Clavien-Dindo≥IIIb）发生率为 14%（5/35），术后死亡率为 3%（1/35）。
保留胰腺的十二指肠切除术对原发性十二指肠肿瘤的治疗有用，并且是某些具有十二指肠浸润或在急诊干预时的一种技术选择。
