Publication:

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

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.