TY - JOUR
TI - Non-whipple operations in the management of benign, premalignant and early cancerous duodenal lesions
AU - Papalampros, A.
AU - Moris, D.
AU - Petrou, A.
AU - Dimitrokallis, N.
AU - Karavokyros, I.
AU - Schizas, D.
AU - Delladetsima, I.
AU - Pappas, T.N.
AU - Felekouras, E.
JO - ANTICANCER RESEARCH
PY - 2017
VL - 37
TODO - 3
SP - 1443-1452
PB - International Institute of Anticancer Research
SN - 0250-1291
TODO - 10.21873/anticanres.11468
TODO - adenomatosis;  adult;  aged;  benign neoplasm;  clinical article;  clinical outcome;  controlled study;  data base;  duodenal adenocarcinoma;  duodenal adenoma;  duodenal adenomatosis;  duodenal dysplasia;  duodenum cancer;  duodenum carcinoma;  duodenum polyp;  duodenum stenosis;  early cancer;  enteritis;  Fogarty catheter;  follow up;  gastrectomy Billroth II;  gastrointestinal stapler;  gastrointestinal stromal tumor;  histopathology;  human;  human tissue;  intermethod comparison;  intestine surgery;  middle aged;  operation duration;  pancreas preserving duodenectomy;  partial duodenectomy;  patient selection;  polydioxanone suture;  polyglactin suture;  polypropylene suture;  postoperative complication;  precancer;  preoperative period;  priority journal;  retrospective study;  Review;  surgical technique;  transduodenal ampullectomy;  very elderly;  vessel sealing system;  villous adenoma;  algorithm;  ampulla of Vater;  anastomosis;  decision making;  Duodenal Neoplasms;  female;  inflammation;  male;  pathology;  postoperative complication;  procedures;  surgical oncology;  treatment outcome;  tumor recurrence, Adult;  Aged;  Aged, 80 and over;  Algorithms;  Ampulla of Vater;  Anastomosis, Surgical;  Decision Making;  Duodenal Neoplasms;  Female;  Follow-Up Studies;  Humans;  Inflammation;  Male;  Middle Aged;  Neoplasm Recurrence, Local;  Operative Time;  Postoperative Complications;  Retrospective Studies;  Surgical Oncology;  Treatment Outcome
TODO - Aim: We reviewed our 20-year experience with non-Whipple operations (pancreas-preserving duodenectomy and transduodenal ampullectomy) for the treatment of benign, premalignant or early-stage malignant duodenal lesions. Patients and Methods: Twenty-four patients who underwent non-Whipple operations between January 1996 and December 2015 were identified from an institutional database and retrospectively analyzed. Results: Between 1996 and 2015, 10 patients underwent pancreas-preserving duodenectomy and 14 patients underwent transduodenal ampullectomy. The mean follow-up was 25.8 months (range=6-54 months) and no patient was lost to follow-up. Eighteen patients had preoperative diagnosis of duodenal adenomatosis, three patients had preoperative diagnosis of duodenal adenocarcinoma, one had a bleeding polyp and two had localized inflammation. Average operative time was 145 min (range=127-168 min) for transduodenal ampullectomy and 183 min (range=173-200 min) for pancreas-preserving duodenectomy (p<0.05). The estimated blood loss for transduodenal ampullectomy was 85 vs. 125 ml for pancreas-preserving duodenectomy (p<0.05). Early postoperative complications were noted in 13 cases (54.17%). There were no postoperative (90-day) deaths observed in this series and there were no recurrences during follow-up for the patients operated on with neoplastic lesions. Conclusion: For carefully selected patients, transduodenal ampullectomy and pancreas-preserving duodenectomy may be used in place of the Whipple operation for benign and occasionally early-stage malignant (Tis and T1) duodenal and ampullary disease.
ER -