Long-Term Outcomes of Pancreas-Sparing Duodenectomy for Duodenal Polyposis in Familial Adenomatous Polyposis Syndrome.
Duodenal adenoma
Duodenal polyposis
Familial adenomatous polyposis
Pancreas-sparing duodenectomy
Polyp
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
04
03
2020
accepted:
19
04
2020
pubmed:
16
5
2020
medline:
29
5
2021
entrez:
16
5
2020
Statut:
ppublish
Résumé
Pancreas-sparing duodenectomy (PSD) offers definitive therapy for duodenal polyposis associated with familial adenomatous polyposis (FAP). We reviewed the long-term complications of PSD and evaluated the incidence of high-grade dysplasia (HGD) and cancer in the remaining upper gastrointestinal tract. Forty-seven FAP patients with duodenal polyposis undergoing PSD from 1992 to 2019 were reviewed. Long-term was defined as > 30 days from PSD. All patients were treated with an open technique, and 43 (91.5%) had Spigelman stage III or IV duodenal polyposis. Median follow-up was 107 months (IQR, 26-147). There was no 90-day mortality. Seven patients died at a median of 10.5 years (IQR, 5.4-13.3) after PSD, with one attributed to gastric cancer. Pancreatitis occurred in 10 patients (21.3%), and two required surgical intervention. Seven patients (14.9%) developed an incisional hernia, and all underwent definitive repair. Forty-one patients (87.2%) had postoperative surveillance endoscopy over a median follow-up of 111 months (IQR, 42-138). Three patients (6.4%) developed adenocarcinoma (two gastric, one jejunal), and four (8.5%) had adenomas with HGD (two gastric, two jejunal) with a median of 15 years (IQR, 9-16) from PSD. One patient with gastric adenocarcinoma and all patients with HGD or adenocarcinoma of the jejunum required surgical intervention. PSD can be performed with a low but definable risk of long-term morbidity. Risk of gastric and jejunal carcinoma rarely occurs and was diagnosed decades after PSD. This demonstrates the need for lifelong endoscopic surveillance and educates us on the risk of carcinoma in the remaining gastrointestinal tract.
Sections du résumé
BACKGROUND
Pancreas-sparing duodenectomy (PSD) offers definitive therapy for duodenal polyposis associated with familial adenomatous polyposis (FAP). We reviewed the long-term complications of PSD and evaluated the incidence of high-grade dysplasia (HGD) and cancer in the remaining upper gastrointestinal tract.
METHODS
Forty-seven FAP patients with duodenal polyposis undergoing PSD from 1992 to 2019 were reviewed. Long-term was defined as > 30 days from PSD.
RESULTS
All patients were treated with an open technique, and 43 (91.5%) had Spigelman stage III or IV duodenal polyposis. Median follow-up was 107 months (IQR, 26-147). There was no 90-day mortality. Seven patients died at a median of 10.5 years (IQR, 5.4-13.3) after PSD, with one attributed to gastric cancer. Pancreatitis occurred in 10 patients (21.3%), and two required surgical intervention. Seven patients (14.9%) developed an incisional hernia, and all underwent definitive repair. Forty-one patients (87.2%) had postoperative surveillance endoscopy over a median follow-up of 111 months (IQR, 42-138). Three patients (6.4%) developed adenocarcinoma (two gastric, one jejunal), and four (8.5%) had adenomas with HGD (two gastric, two jejunal) with a median of 15 years (IQR, 9-16) from PSD. One patient with gastric adenocarcinoma and all patients with HGD or adenocarcinoma of the jejunum required surgical intervention.
CONCLUSION
PSD can be performed with a low but definable risk of long-term morbidity. Risk of gastric and jejunal carcinoma rarely occurs and was diagnosed decades after PSD. This demonstrates the need for lifelong endoscopic surveillance and educates us on the risk of carcinoma in the remaining gastrointestinal tract.
Identifiants
pubmed: 32410179
doi: 10.1007/s11605-020-04621-7
pii: 10.1007/s11605-020-04621-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1233-1240Commentaires et corrections
Type : CommentIn
Type : CommentIn
Références
Bulow S, Bjork J, Christensen IJ, et al. Duodenal adenomatosis in familial adenomatous polyposis. Gut. 2004; 53: 381-86
doi: 10.1136/gut.2003.027771
Offerhaus GJ, Giardello FM, Krush AJ, et al. The risk of upper gastrointestinal cancer in familial adenomatous polyposis. Gastroenterology. 1992; 102(6): 1980-2.
doi: 10.1016/0016-5085(92)90322-P
Groves CJ, Saunders BP, Spigelman AD, et al. Duodenal cancer in patients with familial adenomatous polyposis (FAP): results of a 10 year prospective study. Gut. 2002; 50(5): 636-41.
doi: 10.1136/gut.50.5.636
Spigelman AD, Williams CB, Talbot IC, et al. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet. 1989; 2: 783-85.
doi: 10.1016/S0140-6736(89)90840-4
Johnson MD, Mackey R, Brown N, et al. Outcome based on management for duodenal adenomas: sporadic versus familial disease. J Gastrointest Surg. 2010; 14(2): 229-35.
doi: 10.1007/s11605-009-1091-4
Mackey R, Walsh RM, Chung R, et al. Pancreas-sparing duodenectomy is effective management for familial adenomatous polyposis. J Gastrointest Surg. 2005; 9(8): 1088-93
doi: 10.1016/j.gassur.2005.07.021
Kalady MF, Clary BM, Tyler DS, et al. Pancreas-preserving duodenectomy in the management of duodenal familial adenomatous polyposis. J Gastrointest Surg. 2002: 6(1): 82-7.
doi: 10.1016/S1091-255X(01)00005-1
Walsh RM, Augustin T, Aleassa EM, et al. Comparison of pancreas-sparing duodenectomy (PSD) and pancreatoduodenectomy (PD) for the management of duodenal polyposis syndromes. Surgery. 2019; 166(4): 496-502.
doi: 10.1016/j.surg.2019.05.060
Chung RS, Church JM, vanStolk R. Pancreas-sparing duodenectomy: indications, surgical technique, and results. Surgery. 1995; 117(3): 254-59.
doi: 10.1016/S0039-6060(05)80198-9
Augustin T, Moslim MA, Tang A, et al. Tailored surgical treatment of duodenal polyposis in familial adenomatous polyposis syndrome. Surgery. 2018; 163:594-99.
doi: 10.1016/j.surg.2017.10.035
Yoon JY, Mehta N, Burke CA, et al. The Prevalence and Significance of Jejunal and Duodenal Bulb Polyposis After Duodenectomy in Familial Adenomatous Polyposis: Retrospective Cohort Study. Ann Surg. 2019; in press.
Ganschow P, Hackert T, Biegler M, et al. Postoperative outcome and quality of life after surgery for FAP-associated duodenal adenomatosis. Langenbecks Arch Surg. 2018; 403(1): 93-102.
doi: 10.1007/s00423-017-1625-2
Mankaney G, Leone P, Cruise M, et al. Gastric cancer in FAP: a concerning rise in incidence. Fam Cancer. 2017; 16(3): 371-6.
doi: 10.1007/s10689-017-9971-3
Fink C, Baumann P, Wente MN, et al. Incisional hernia rate 3 years after midline laparotomy. Br J Surg. 2014; 101(2): 51-4.
doi: 10.1002/bjs.9364
Deerenberg EB, Harlaar JJ, Steyerberg EW, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet. 2015; 386(10000): 1254-1260.
doi: 10.1016/S0140-6736(15)60459-7
Diener MK, Voss S, Jensen K, et al. Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg. 2010; 251(5): 843-56.
doi: 10.1097/SLA.0b013e3181d973e4
Itatsu K, Yokoyama Y, Sugawara G, et al. Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg. 2014; 101(11): 1439-47.
doi: 10.1002/bjs.9600
Al-Sarireh B, Ghaneh P, Gardner-Thorpe J, et al. Complications and follow-up after pancreas-preserving total duodenectomy for duodenal polyps. Br J Surg. 2008; 95(12): 1506-11.
doi: 10.1002/bjs.6412
D’Angelica M, Maddineni S, Fong Y, et al. Optimal abdominal incision for partial hepatectomy: increased late complications with Mercedes-type incisions compared to extended right subcostal incisions. World J Surg. 2006; 30(3): 410-18.
doi: 10.1007/s00268-005-0183-x
Donataccio M, Genco B, Donataccio D. Right subcostal incision in liver transplantation: prospective study of feasibility. Transplant Proc. 2006; 38(4): 1109-10.
doi: 10.1016/j.transproceed.2006.03.044
Nakayama Y, Konishi M, Gotohda N, et al. Comparison of postoperative early and late complications between pancreas-sparing duodenectomy and pancreatoduodenectomy. Surg Today. 2017; 47(6): 705-11.
doi: 10.1007/s00595-016-1418-1