Outcomes of Pancreas‐Sparing Total Duodenectomy for Severe Duodenal Polyposis in Patients With Familial Adenomatous Polyposis

TL;DR

This study examines the effectiveness of a specific surgery for preventing duodenal cancer in patients with a genetic condition called familial adenomatous polyposis.

Contribution

The study provides new insights into the surgical and oncological outcomes of pancreas-sparing total duodenectomy for severe duodenal polyposis in FAP patients.

Findings

PSTD had notable but manageable postoperative complications, with no mortalities observed.

Long-term follow-up showed a 10-year survival rate of 87.4% after PSTD.

Extraduodenal malignancies occurred in some patients, highlighting the need for continued surveillance.

Abstract

Spigelman stage IV duodenal polyposis (SP‐stage IV DP) is associated with high duodenal cancer risk in patients with familial adenomatous polyposis (FAP). This study evaluated the surgical and oncological outcomes of pancreas‐sparing total duodenectomy (PSTD) as a surgical prophylaxis for severe duodenal polyposis in FAP.

Medical records were reviewed to evaluate factors concerning short‐ and long‐term clinical and oncological outcomes in consecutive patients with FAP who underwent PSTD for SP‐stage IV DP.

There were twenty‐seven patients (median age: 48 years) from 26 families, of whom 12 were female. Clavien–Dindo grade IIIa/IIIb complications included delayed gastric emptying (n = 14) and pancreatic fistula (n = 10); no mortalities were observed. Histopathological examinations revealed no malignant neoplasms deeper than T1a in the duodenum and ampulla. Follow‐up (median 6.4 years) revealed anastomotic stricture of the reconstructed neo‐common channel (n = 5), anastomotic ulcer of the gastrojejunostomy site (n = 5), acute pancreatitis (n = 4), and acute cholangitis (n = 2), all of which were successfully treated endoscopically or conservatively. Malignant neoplasms after PSTD included gastric cancer (n = 3), remnant ano‐rectal cancer (n = 3), ileal cancer (n = 1), ileal pouch cancer (n = 1), and endometrial cancer (n = 1). The cumulative 10‐year survival rate following PSTD was 87.4%.

PSTD for the prophylactic management of SP‐stage IV DP was associated with notable but manageable postoperative morbidity. Long‐term surveillance remains essential for the development of extraduodenal malignancies to confirm the oncological efficacy of this type of surgery.

This study evaluated the surgical and oncological outcomes of pancreas‐sparing total duodenectomy (PSTD) as a surgical prophylaxis for severe duodenal polyposis in 27 cases of FAP.

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