Outcomes of Pancreas‐Sparing Total Duodenectomy for Severe Duodenal Polyposis in Patients With Familial Adenomatous Polyposis
Year: 2025
Type: article
Study design: Observational Study
Abstract: ABSTRACT Aim Spigelman stage IV duodenal polyposis (SP‐stage IV DP) is associated with high duodenal cancer risk in patients with familial adenomatous polyposis (FAP). This study evaluated the surgical and oncological outcomes of pancreas‐sparing total duodenectomy (PSTD) as a surgical prophylaxis for severe duodenal polyposis in FAP. Methods Medical records were reviewed to evaluate factors concerning short‐ and long‐term clinical and oncological outcomes in consecutive patients with FAP who underwent PSTD for SP‐stage IV DP. Results There were twenty‐seven patients (median age: 48 years) from 26 families, of whom 12 were female. Clavien–Dindo grade IIIa/IIIb complications included delayed gastric emptying ( n = 14) and pancreatic fistula ( n = 10); no mortalities were observed. Histopathological examinations revealed no malignant neoplasms deeper than T1a in the duodenum and ampulla. Follow‐up (median 6.4 years) revealed anastomotic stricture of the reconstructed neo‐common channel ( n = 5), anastomotic ulcer of the gastrojejunostomy site ( n = 5), acute pancreatitis ( n = 4), and acute cholangitis ( n = 2), all of which were successfully treated endoscopically or conservatively. Malignant neoplasms after PSTD included gastric cancer ( n = 3), remnant ano‐rectal cancer ( n = 3), ileal cancer ( n = 1), ileal pouch cancer ( n = 1), and endometrial cancer ( n = 1). The cumulative 10‐year survival rate following PSTD was 87.4%. Conclusions PSTD for the prophylactic management of SP‐stage IV DP was associated with notable but manageable postoperative morbidity. Long‐term surveillance remains essential for the development of extraduodenal malignancies to confirm the oncological efficacy of this type of surgery.
DOI: 10.1002/ags3.70125
Authors: Takehiro Shiraishi, Hideyuki Ishida, Takatoshi Matsuyama, Noriyasu Chika, Yoshiko Mori, Norimichi Chiyonobu, Youichi Kumagai, Ibuki Fujinuma, Toshiro Ogura
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,350
OpenAlex ID: W7106295103