|
|
Back to 2016 Annual Meeting
Comparative Analysis of Techniques and Outcomes for Resection of Benign or Low-Grade Neoplasms in the Duodenum
Angelena Crown*, Kimberly Bertens, Adnan A. Alseidi, Thomas R. Biehl, Scott Helton, Flavio G. Rocha
Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA
Background: Tumors in the duodenum present unique anatomic, technical, and oncologic challenges for surgical resection due to their retroperitoneal location and proximity to the ampulla and mesenteric vessels. Neoplasms that do not require lymphadenectomy can often undergo limited, organ-sparing resections (See Figure 1). We sought to compare the indications, operative strategies, and outcomes for benign or low-grade duodenal neoplasms between local and more extended resections.
Methods: Retrospective review of electronic medical records and pathologic specimens of patients undergoing resection of non-carcinomatous duodenal neoplasms from 2005-2015 was performed. Demographic, clinical and pathologic information, length of stay, blood loss, complications, readmission, and mortality were analyzed. Statistical comparisons between groups were made by Student’s t-tests and Chi-square tests.
Results: Forty-six patients with duodenal neoplasms (gastrointestinal stromal tumor or leiomyoma=16 and tubulovillous adenoma=30) were identified of which 28 underwent pancreaticoduodenectomy (PD) and 18 underwent local resection (LR) (See Table 1). Compared to LR, there was no difference in age (57 vs 63 years, p=0.11) or lesion size (3.9 vs 3.9 cm, p=0.98) for PD patients. Blood loss, length of stay, and complications were significantly increased in the PD vs LR cohort (324 vs 80 cc, p=0.05), (12 vs 7 days, p=0.04), and (65% vs 29%, p=0.02), respectively. Rate of clinically significant pancreatic fistula (Grades B and C) was 32% in the PD group and 17% in the LR group, p=0.32. Ninety day mortality and readmission rates were not significantly different between PD and LR patients (3.6% vs 0%, p=0.6) and (36% vs 22%, p=0.33), respectively. All patients except for one in the PD group had involvement of D2. Twelve patients in the LR group required resection of 2 or more duodenal segments. D3 was the most commonly affected segment in 12 patients, followed by D2 (8), D4 (4), and D1 (2). Most common reconstruction strategies in the LR group were transverse closure of the duodenum (8), side-side duodenojejunostomy (5), end-side duodenojejunostomy (2), end-end duodenoduodeonstomy (1), side-end duodenojejunostomy, and end-end duodenojejunostomy (1).
Conclusions: LR is safe and associated with reduced length of stay and morbidity than PD for benign or low-grade neoplasms of the duodenum. This less invasive surgical approach should be considered in amenable lesions and suitable patients if technically feasible.
Comparison of Patient Demographics, Tumor Factors, and Outcomes between Patients Undergoing Local Resection and Pancreaticoduodenectomy for Duodenal Tumors
| Parameter | Local Resection N=18 | Pancreaticoduodenectomy N=28 | P-value | | Patient Age | 57 years | 63 years | p=0.11 | Histology: Tubulovillous Adenoma
GIST/Leiomyoma | 10
8 | 20
8 | p=0.29 | | Mitotic Rate of GISTs | 1.8 mitoses/50 HPF | 2.4 mitoses/50 HPF | p=0.62 | | Tumor Size | 3.9 cm | 3.9 cm | p=0.98 | | Blood Loss | 80 cc | 324 cc | p=0.05 | | Complication Rate | 29% | 65% | p=0.02 | | Readmission Rate | 22% | 36% | p=0.33 | | Pancreatic Fistula (B,C) | 17% | 32% | p=0.32 | | Length of Stay | 7 days | 12 days | p=0.04 |
 Figure 1. Local resection of duodenal tumor (a) with identification of ampulla of Vater (b) and transverse duodenoduodenostomy (c).
Back to 2016 Annual Meeting
|
