PANCREAS-SPARING DUODENECTOMY FOR INFRA-AMPULLARY DUODENAL PATHOLOGY DISTAL

BACKGROUND: Surgical management of distal duodenal pathology is challe nging because of the duodenum's retroperitoneal location and its share d blood supply with the pancreas. For infra-ampullary pathology, surgi cal treatment may include local excision, pancreaticoduodenectomy, or pancreas-sparing duodenectomy (PSD). PATIENTS AND METHODS: We retrospe ctively reviewed the management of 24 patients with infra-ampullary du odenal pathology treated by PSD between 1985 and 1994 at The Johns Hop kins Hospital. RESULTS: There were 16 men and 8 women with a mean age of 51.2 +/- 4.4 years. The indications for elective PSD in 19 patients were neoplasms (n = 15), Crohn's disease (n = 2), and other (n = 2). Of the neoplasms, 13 were malignant (11 adenocarcinoma, 1 lymphoma, 1 liposarcoma) and 2 were benign (1 villous adenoma, 1 benign stromal tu mor). Five patients had PSD as an emergency procedure for penetrating trauma. The mean follow-up is 24.2 +/- 5.8 months (range 1 to 122). In the group undergoing elective PSD, the mean length of operation was 5 .3 +/- 0.4 hours, and the estimated blood loss was 569 +/- 121 mt. In the entire series, there was 1 postoperative death from an anastomotic leak and 1 reexploration for anastomotic bleeding. Pancreas-sparing d uodenectomy in patients with trauma or benign duodenal pathology resul ted in a good outcome in all. In those 11 patients with duodenal adeno carcinoma, 7 have died, 2 have had recurrences, and 2 are disease free . Actuarial and disease-free, 2-year survival rates in the 11 patients with duodenal adenocarcinoma were 33% and 14%, respectively. CONCLUSI ONS: Pancreas-sparing duodenectomy is a safe and effective treatment i n patients with distal duodenal benign neoplasms or trauma, and PSD ap pears to have limited effectiveness for malignant distal duodenal path ology.