Pancreas sparing duodenectomy versus pancreaticodudoenectomy for duodenal carcinoma: a comparison study

Authors

  • Maheswaran Pitchaimuthu The Liver and HPB Unit, Queen Elizabeth Hospital, Birmingham
  • Mohammad S. Khan The Liver and HPB Unit, Queen Elizabeth Hospital, Birmingham
  • S. Pearson The Liver and HPB Unit, Queen Elizabeth Hospital, Birmingham
  • Chris Coldham The Liver and HPB Unit, Queen Elizabeth Hospital, Birmingham
  • James Hodson The Liver and HPB Unit, Queen Elizabeth Hospital, Birmingham
  • Ravi Marudanayagam The Liver and HPB Unit, Queen Elizabeth Hospital, Birmingham
  • John K Roberts The Liver and HPB Unit, Queen Elizabeth Hospital, Birmingham
  • Paolo Muiesan The Liver and HPB Unit, Queen Elizabeth Hospital, Birmingham
  • John Isaac The Liver and HPB Unit, Queen Elizabeth Hospital, Birmingham
  • Darius F. Mirza The Liver and HPB Unit, Queen Elizabeth Hospital, Birmingham
  • Robert P. Sutcliffe The Liver and HPB Unit, Queen Elizabeth Hospital, Birmingham

DOI:

https://doi.org/10.18203/2349-2902.isj20161480

Keywords:

Pancreas sparing duodenectomy (PSD), Pancreatico duodenectomy (PD), Lymph node yield, Lymph node ratio (LNR), Survival

Abstract

Background: Pancreas-sparing duodenectomy (PSD) may be an alternative to pancreaticoduodenectomy (PD) for duodenal cancers located distant from the ampulla. PSD avoids the potential complications of a pancreaticoenteric anastomosis, but the long-term outcomes are unknown.

Methods: Patients who underwent surgical resection of duodenal cancer were identified from a prospectively maintained database. Clinical and pathological data were collected, and long-term cancer-related outcomes were analyzed.

Results: 19 patients underwent PSD and 60 PD between January 1993 and March 2014. Morbidity (p=0.196), 90-day mortality (p=0.379) and length of stay (p=0.137) were similar in both groups. However, there were more anastomotic leaks in the PD group (33% versus. 5%; p=0.017). Lymph node yield (p<0.001) was significantly lower after PSD.  There was no significant difference in five-year overall (p=0.943), disease-specific (p=0.781) or recurrence-free (p=0.695) survival rates. No significant difference in the lymph node ratio (LNR) between the groups.

Conclusions: PSD avoids the risks of a pancreatic anastomosis associated with PD. Despite a significantly lower lymph node harvest, similar survival outcomes can be achieved with PSD in patients with duodenal carcinoma not involving D2.

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Published

2016-12-09

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Section

Original Research Articles