Amsterdam UMC location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.
Amsterdam UMC location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
HPB (Oxford). 2022 Oct;24(10):1642-1650. doi: 10.1016/j.hpb.2022.04.004. Epub 2022 Apr 26.
In patients with familial adenomatous polyposis (FAP), extensive nonmalignant duodenal polyposis not amenable to endoscopic management demands surgical resection for which pancreas-preserving total duodenectomy (PPTD) offers a pancreatic parenchyma sparing approach.
This is a retrospective cohort study including consecutive patients who underwent PPTD for FAP. Reconstruction involved a Billroth II anastomosis with a short isolated jejunal limb to facilitate future endoscopic surveillance. Short and long-term outcomes were evaluated.
Overall, 30 patients underwent PPTD for Spigelman stage III (n = 6) or IV (n = 24). Sixteen patients experienced a severe complication (Clavien-Dindo grade III/IV) including postoperative pancreatic fistula (ISGPS grade B/C) in twelve. There was no all cause in-hospital and 90-day mortality. During follow-up (median 125 months), five patients developed acute pancreatitis, one new-onset diabetes and one exocrine pancreatic insufficiency. During endoscopic surveillance in 27 patients, jejunal adenomas were detected in 22 and advanced adenomas in 11. An additional surgical resection was required in four patients with extensive jejunal polyposis. None developed jejunal cancer. The 10-year overall survival rate was 93.3%.
Postoperative morbidity after PPTD is substantial but on the long-term, rates of pancreatic insufficiencies are low. Most patients develop jejunal adenomas at follow-up, highlighting the need for endoscopic surveillance.
在家族性腺瘤性息肉病（FAP）患者中，广泛的无法通过内镜治疗的非恶性十二指肠息肉需要手术切除，保留胰腺的全十二指肠切除术（PPTD）为保留胰腺实质提供了一种方法。
这是一项回顾性队列研究，纳入了连续接受 PPTD 治疗 FAP 的患者。重建采用 Billroth II 吻合术，带有短的孤立空肠襻，以便将来进行内镜监测。评估了短期和长期结果。
总体而言，有 30 名患者因 Spigelman 分期 III（n=6）或 IV（n=24）接受了 PPTD。16 名患者出现严重并发症（Clavien-Dindo 分级 III/IV），包括 12 名患者发生术后胰瘘（ISGPS 分级 B/C）。无院内和 90 天全因死亡率。在随访期间（中位数 125 个月），5 名患者发生急性胰腺炎，1 名新诊断为糖尿病，1 名发生外分泌胰腺功能不全。在 27 名接受内镜监测的患者中，22 名患者发现空肠腺瘤，11 名患者发现高级别腺瘤。4 名患者因广泛空肠息肉需要再次手术切除。无患者发生空肠癌。10 年总生存率为 93.3%。
PPTD 后的术后发病率较高，但长期来看，胰腺功能不全的发生率较低。大多数患者在随访中出现空肠腺瘤，突出了内镜监测的必要性。
