Fujinuma Ibuki, Ogura Toshiro, Takahashi Ayano, Nomura Satoshi, Kitamura Kei, Takahashi Amane, Shiraishi Takehiro, Mori Yoshiko, Ishiguro Toru, Matsuyama Takatoshi, Kumagai Youichi, Ishida Hideyuki
Department of Gastroenterological Surgery Saitama Cancer Center Saitama Japan.
Department of Digestive Tract and General Surgery, Saitama Medical Center Saitama Medical University Saitama Japan.
Ann Gastroenterol Surg. 2025 Jan 29;9(4):822-829. doi: 10.1002/ags3.12919. eCollection 2025 Jul.
Severe duodenal polyposis associated with familial adenomatous polyposis considerably increases the risk of duodenal cancer. Pancreas-sparing total duodenectomy is an alternative surgical approach for managing severe duodenal polyposis. This study evaluated the postoperative nutritional outcomes following pancreas-sparing total duodenectomy in patients with severe duodenal polyposis associated with familial adenomatous polyposis.
This retrospective analysis compared 28 patients who underwent pancreas-sparing total duodenectomy for Spigelman stage IV duodenal polyposis with 29 patients who underwent pancreatoduodenectomy for low-malignancy duodenal neoplasms. Patient demographics, postoperative complications, and nutritional parameters were analyzed at 3, 6, 9, and 12 months postoperatively.
Compared with patients in the pancreatoduodenectomy group, those in the pancreas-sparing total duodenectomy group were younger and had a higher incidence of previous abdominal surgeries ( < 0.01). Postoperatively, the pancreas-sparing total duodenectomy group showed significantly better preservation of total protein, albumin, and total cholesterol levels, body mass index, body weight, and psoas major muscle area compared to the pancreatoduodenectomy group ( < 0.05). Additionally, glucose tolerance was better maintained in the pancreas-sparing total duodenectomy group than in the pancreatoduodenectomy group ( < 0.01), with no patients requiring the initiation of insulin therapy or experiencing the exacerbation of diabetes.
Pancreas-sparing total duodenectomy effectively preserves the postoperative nutritional status in patients with duodenal polyposis associated with familial adenomatous polyposis. This surgical option maintains postoperative nutritional integrity and improves long-term outcomes.
与家族性腺瘤性息肉病相关的严重十二指肠息肉病会显著增加患十二指肠癌的风险。保留胰腺的全十二指肠切除术是治疗严重十二指肠息肉病的一种替代手术方法。本研究评估了保留胰腺的全十二指肠切除术治疗与家族性腺瘤性息肉病相关的严重十二指肠息肉病患者术后的营养结局。
这项回顾性分析比较了28例行保留胰腺的全十二指肠切除术治疗Spigelman IV期十二指肠息肉病的患者与29例行胰十二指肠切除术治疗低恶性十二指肠肿瘤的患者。对患者的人口统计学资料、术后并发症和营养参数在术后3、6、9和12个月进行分析。
与胰十二指肠切除术组患者相比，保留胰腺的全十二指肠切除术组患者更年轻，既往腹部手术发生率更高（<0.01）。术后，与胰十二指肠切除术组相比，保留胰腺的全十二指肠切除术组在总蛋白、白蛋白和总胆固醇水平、体重指数、体重和腰大肌面积的保留方面明显更好（<0.05）。此外，保留胰腺的全十二指肠切除术组比胰十二指肠切除术组能更好地维持糖耐量（<0.01），没有患者需要开始胰岛素治疗或糖尿病病情加重。
保留胰腺的全十二指肠切除术有效地保留了与家族性腺瘤性息肉病相关的十二指肠息肉病患者术后的营养状况。这种手术选择维持了术后营养完整性并改善了长期结局。
