SURGICAL-TREATMENT OF SEVERE DUODENAL POLYPOSIS IN FAMILIAL ADENOMATOUS POLYPOSIS

Background Patients with familial adenomatous polyposis (FAP) are at r isk for adenomas and cancers in the duodenum but the ideal management of duodenal polyposis remains uncertain. Methods The outcome of surgic al resection was analysed in 18 patients with FAP who had severe duode nal polyposis. Results Duodenotomy and clearance of duodenal adenomas was performed seven times in six patients. There were two duodenal lea ks and, after a mean follow-up of 53 (range 36-72) months, duodenal ad enomas recurred in all patients and five had severe polyposis. Pancrea toduodenectomy was performed in seven patients with severe duodenal po lyposis. Histology of the specimens revealed two unsuspected duodenal carcinomas at an early stage. After a mean follow-up of 42 months all patients were alive and well, and there was no case of jejunal polypos is. Pancreatoduodenectomy was attempted in five patients with duodenal cancer and only one survived more than 4 years. Conclusion Surgical e xcision of duodenal adenomas should be discussed before carcinoma occu rs. Surgical polypectomy fails to guarantee a polyp-free duodenum and carries a risk of postoperative complications whereas pancreatoduodene ctomy eliminates the risk of duodenal cancer with an acceptable morbid ity rate. Pancreatoduodenectomy could be offered to some patients with large or multiple villous duodenal adenomas repeatedly showing severe dysplasia.