Surgical Treatment for Duodenal Polyposis by Pancreas-preserving Total Duodenectomy in Familial Adenomatous Polyposis

Takuya Matsumoto, Satoshi Nagayama, Akira Mori, Ryuichiro Doi, Hisashi Onodera and Masayuki Imamura

Surgery and Surgical Basic Science, Graduate School of Medicine, Kyoto University

Duodenal adenomas occur frequently in patients with familial adenomatous polyposis (FAP). Similar to colorectal polyps, duodenal adenomas, especially those in periampullary regions, may become malignant and duodenal adenocarcinoma is a major cause of death in patients who have had previous proctocolectomy. Although prophylactic pancreaticoduodenectomy is a treatment option, pancreas-preserving total duodenectomy (PPTD) is less radical and safer. This approach is advocated because the normal pancreas should be spared if at all possible. A 40-year-old man with FAP underwent total colorectal resection for profuse adenoma and concomitant rectal cancer. Four months after surgery, metastatic lesions were evident in the liver and diffuse duodenal polyposis was also noted. We conducted right lobectomy for liver metastases and prophylactic PPTD reconstructed by the Billroth-I method for the diffuse duodenal polyposis. The postoperative course was uneventful, and free of suture failure, pancreatic fistulas, and bile leakage. The patient could eat satisfactorily and returned to daily life without sequelae. PPTD is a theoretically optimal procedure for resectioning benign, profuse duodenal adenomas and, with the introduction of vessel sealing, can be done safely without major intraoperative problems. Although it is necessary to follow these patients up long-term to fully assess the completeness of tumor removal using PPTD and to rule out postoperative problems, we conclude that PPTD is an effective treatment for duodenal polyposis in FAP patients.

Key words
familial adenomatous polyposis, duodenal polyposis, pancreas-preserving total duodenectomy

Reprint requests
Satoshi Nagayama Surgery and Surgical Basic Science, Graduate School of Medicine, Kyoto University
54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 JAPAN

Accepted
September 22, 2004

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