Is there an advantage in performing a pancreas-preserving total duodenectomy in duodenal adenomatosis?

Müller, Michael W.; Dahmen, Rolf; Köninger, Jörg; Michalski, Christoph W.; Hinz, Ulf; Hartel, Mark; Kadmon, Martina; Kleeff, Jörg; Büchler, Markus W.; Friess, Helmut

doi:10.1016/j.amjsurg.2007.08.061

« Previous Next »The American Journal of Surgery
Volume 195, Issue 6 , Pages 741-748, June 2008

Is there an advantage in performing a pancreas-preserving total duodenectomy in duodenal adenomatosis?

Michael W. Müller, M.D.
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, D-81675 Munich, Germany
- Department of General Surgery, University of Heidelberg, Im Neurenheimer Feld 110, D 69120 Heidelberg, Germany
Rolf Dahmen, M.D.
- Department of General Surgery, University of Heidelberg, Im Neurenheimer Feld 110, D 69120 Heidelberg, Germany
Jörg Köninger, M.D.
- Department of General Surgery, University of Heidelberg, Im Neurenheimer Feld 110, D 69120 Heidelberg, Germany
Christoph W. Michalski, M.D.
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, D-81675 Munich, Germany
- Department of General Surgery, University of Heidelberg, Im Neurenheimer Feld 110, D 69120 Heidelberg, Germany
Ulf Hinz, MSc
- Department of General Surgery, University of Heidelberg, Im Neurenheimer Feld 110, D 69120 Heidelberg, Germany
Mark Hartel, M.D.
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, D-81675 Munich, Germany
- Department of General Surgery, University of Heidelberg, Im Neurenheimer Feld 110, D 69120 Heidelberg, Germany
Martina Kadmon, M.D.
- Department of General Surgery, University of Heidelberg, Im Neurenheimer Feld 110, D 69120 Heidelberg, Germany
Jörg Kleeff, M.D.
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, D-81675 Munich, Germany
- Department of General Surgery, University of Heidelberg, Im Neurenheimer Feld 110, D 69120 Heidelberg, Germany
Markus W. Büchler, M.D.
- Department of General Surgery, University of Heidelberg, Im Neurenheimer Feld 110, D 69120 Heidelberg, Germany
Helmut Friess, M.D.
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, D-81675 Munich, Germany
- Department of General Surgery, University of Heidelberg, Im Neurenheimer Feld 110, D 69120 Heidelberg, Germany
- Corresponding author. Tel: +49 89 4140 2120; fax: +49 89 4140 4870.

Received 20 April 2007; received in revised form 31 July 2007 published online 24 April 2008.

Abstract

Background

Duodenal adenomatosis is a premalignant condition often not treatable by local resection or endoscopy. An option for treatment is a pylorus-preserving (pp)-Whipple resection. Since the introduction of pancreas-preserving total duodenectomy (PPTD), the question has arisen whether a pp-Whipple resection is still needed to treat duodenal adenomatosis.

Patients and methods

In a 5-year period 23 PPTDs were performed for duodenal adenomatosis. In a matched-pairs analysis the outcome following PPTD (16 patients with a follow-up longer than 12 months) was compared with pp-Whipple.

Results

Hospital mortality in all 23 patients was 4.3% and total morbidity 30% after PPTD. Operation time, intensive care and hospital stay, morbidity, and mortality were comparable between the matched paired groups (16 patients). Patients with PPTD had significantly lower intraoperative blood loss. No PPTD patient required pancreatic enzyme substitution, compared with 12 patients after pp-Whipple. Quality-of-life analysis in PPTD patients revealed no difference compared to a normal control population and the pp-Whipple group.

Conclusions

PPTD is a safe surgical procedure for duodenal adenomatosis that avoids pancreatic head resection, provides high quality of life, and shows advantages over the pp-Whipple procedure.

Keywords: Duodenal adenomatosis, Familial adenomatous polyposis, Pancreas-preserving total duodenectomy, Pylorus-preserving Whipple, Quality of life, Surgery