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01-09-2012 | Gastrointestinal Oncology

Severe Duodenal Involvement in Familial Adenomatous Polyposis Treated by Pylorus-Preserving Pancreaticoduodenectomy

Authors: Frédéric Caillié, MD, François Paye, MD, PhD, Benoit Desaint, MD, Malika Bennis, MD, Jérémie H. Lefèvre, MD, Yann Parc, MD, PhD, Magali Svrcek, MD, PhD, Pierre Balladur, MD, PhD, Emmanuel Tiret, MD

Published in: Annals of Surgical Oncology | Issue 9/2012

Abstract

Purpose

Pancreaticoduodenectomy is an alternative to pancreas-sparing duodenectomy for radical treatment of duodenal lesions. The aims of this study were to assess the results of pylorus-preserving pancreaticoduodenectomy (PPPD) for severe duodenal polyposis in familial adenomatous polyposis in terms of morbidity, long-term influence on functional results, the recurrence rate of cancer or jejunal polyps, and survival.

Methods

All patients operated on for a PPPD between 1992 and 2009 were included. Clinical data, endoscopic findings, and pathologic examinations were evaluated.

Results

A total of 19 patients underwent PPPD for severe duodenal polyposis (17 Spigelman IV, 1 Spigelman III, and 1 invasive carcinoma). Postoperative mortality was nil. The postoperative morbidity rate was 42%, including 4 pancreatic fistulae (21%) and 2 delayed gastric emptying (11%). Pathologic examination found 7 invasive carcinomas, of which only 1 was known before resection. One third of patients operated on without a preoperative diagnosis of malignancy already had an invasive duodenal carcinoma. After a mean follow-up of 58 months, 16 patients were alive. Thirteen patients underwent endoscopic follow-up, and new adenomas were found in 4 (31%). All were treated successfully during the same endoscopic procedure. PPPD did not modify the functional result after coloproctectomy.

Conclusions

PPPD remains a safe and efficient therapeutic option for severe duodenal polyposis in familial adenomatous polyposis patients.

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Title: Severe Duodenal Involvement in Familial Adenomatous Polyposis Treated by Pylorus-Preserving Pancreaticoduodenectomy
Authors: Frédéric Caillié, MD
François Paye, MD, PhD
Benoit Desaint, MD
Malika Bennis, MD
Jérémie H. Lefèvre, MD
Yann Parc, MD, PhD
Magali Svrcek, MD, PhD
Pierre Balladur, MD, PhD
Emmanuel Tiret, MD
Publication date: 01-09-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 9/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2221-x

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Severe Duodenal Involvement in Familial Adenomatous Polyposis Treated by Pylorus-Preserving Pancreaticoduodenectomy

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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