Limited distal duodenal resection: Surgical approach and outcomes. A case series. (June 2018) - Golhar, Ankush
Abstract: Introduction: Tumours involving the duodenum are usually treated with pancreaticoduodenectomy, which may be associated with considerable morbidity. Limited distal duodenal resection, a relatively smaller procedure, can be done in some of these patients. We describe our experience with this operation for such lesions. Methods: We retrospectively analyzed, from prospectively collected data 10 consecutive patients who underwent limited duodenal and proximal jejunal resection between March 2011 and Nov 2015. Results: There were 8 males and 2 females who had a median age of 47 years. Their common presentations were abdominal pain (50%) and upper gastrointestinal bleeding (40%). Five had malignancy (adenocarcinoma: 2, neuroendocrine tumours: 2, non Hodgkin's lymphoma 1). Three had gastrointestinal stromal tumours (GISTs) and 2 had other benign tumours (lipoma 1, ectopic pancreas 1). The 30-day post-operative morbidity rate was 60% (n = 6) with mostly minor complications (Clavien grade 1 or 2). Median post-operative stay was 9 (range, 6–13) days. All ten patients were alive without recurrence after a median follow up of 26.5 months. Conclusion: Limited distal duodenal resection is a feasible surgical alternative to a pancreaticoduodenectomy in carefully selected patients with benign and some malignant tumours of the third and fourth part of the duodenum. Highlights: Pancreaticodudenctomy is the usual treatment for tumours of the duodenum, which still has 30–50% morbidity. Limited resection of the duodenum without pancreatic head resection for benign as well carefully selected malignant tumours of the distal duodenum has considerably lesser morbidity. Cattell and Braash maneuver and mobilization of the ligament of Treitz is very helpful during such resection. The present study suggests the feasibility of performing such limited resection with equivalent survival and oncological outcomes.