Pancreas sparing duodenal resection in colorectal adenocarcinoma with local invasion to the duodenum: a case report and literature review
Background: Pancreas sparing duodenal resection (PSDR) is commonly described in patients with familial duodenal adenomatous polyposis, duodenal gastrointestinal stromal tumours, duodenal trauma, or other primary duodenal lesions where the pancreas is not involved. PSDR in patients with metastatic involvement of the duodenum is rarely described. After reviewing the relevant literature, less than five PSDR for duodenal metastases reports were retrieved. Our patient was treated with PSDR for a local recurrence after a right hemicolectomy performed for right colon adenocarcinoma a year before.
Aim: To investigate if PSDR is feasible in this patient with recurrence of a locally advanced right colon adenocarcinoma invading the duodenum
Case Summary: A 74-year-old female patient presented with right iliac fossa pain and weight loss one year post-resection of the primary ascending colon cancer. A surveillance computed tomography (CT) scan of the thorax, abdomen and pelvis showed a mass in the third segment of the duodenum. The decision to carry out a PSDR was made.
Results: The proximal and distal margins of the resected bowel were uninvolved by the invasive carcinoma, and metastasis in five out of 12 regional lymph nodes was found. The postoperative course was complicated by a grade B postoperative pancreatic fistula (POPF) but recovered well post drainage.
Conclusions: PSDR can be utilized in the management of duodenal metastases.
Relevance for patients: PSDR can be performed in patients with duodenal metastases, offering a lower morbidity rate as compared to conventional pancreaticoduodenectomy.
[1] Li T, D’Cruz RT, Lim SY, Shelat VG. Somatostatin Analogues and the Risk of Post-Operative Pancreatic Fistulas after Pancreatic Resection-a Systematic Review and Meta-Analysis. Pancreatology 2020;20:158-68.
[2] Serene TE, Vishalkumar SG, Padmakumar JS, Terence HC, Keem LJ, Bei W, et al. Predictive Value of Post-Operative Drain Amylase Levels for Post-Operative Pancreatic Fistula. Ann Hepatobiliary Pancreat Surg 2018;22:397-404.
[3] Lu C, Jin W, Mou Y, Shao H, Wu X, Li S, et al. Optimal Laparoscopic Management and Oncological Outcomes of Gastrointestinal Stromal Tumors in Duodenum: Pancreaticoduodenectomy or Pancreas-Sparing Duodenectomy? Cancer Manag Res 2020;12:4725-34.
[4] Burasakarn P, Higuchi R, Nunobe S, Kanaji S, Eguchi H, Okada KI, et al. Limited Resection vs. Pancreaticoduodenectomy for Primary Duodenal Adenocarcinoma: A Systematic Review and MetaAnalysis. Int J Clin Oncol 2021;26:450-60.
[5] Chia CL, Lee AY, Shelat VG, Ahmed S, Junnarkar SP, Woon WW, et al. Does diabetes Mellitus affect Presentation, Stage and Survival in Operable Pancreatic Cancer? Hepatobiliary Surg Nutr 2016;5:38-42.
[6] Konishi M, Kinoshita T, Nakagohri T, Takahashi S, Gotohda N, Ryu M. Pancreas-Sparing Duodenectomy for Duodenal Neoplasms Including Malignancies. Hepatogastroenterology 2007;54:753-7.
[7] Nagai H, Hyodo M, Kurihara K, Ohki J, Yasuda T, Kasahara K, et al. Pancreas-Sparing Duodenectomy: Classification, Indication and Procedures. Hepatogastroenterology 1999;46:1953-8. [8] Cantalejo-Díaz M, Ramia-Ángel JM, PalomaresCano A, Serradilla-Martín M. Pancreas-Preserving Total Duodenectomy: A Systematic Review. Dig Surg 2021;38:186-97.
[9] Mitchell WK, Thomas PF, Zaitoun AM, Brooks AJ, Lobo DN. Pancreas Preserving Distal Duodenectomy: A Versatile Operation for a Range of Infra-Papillary Pathologies. World J Gastroenterol 2017;23:4252-61.
[10] Cirocchi R, Partelli S, Castellani E, Renzi C, Parisi A, Noya G, et al. Right hemicolectomy plus pancreaticoduodenectomy vs partial duodenectomy in treatment of locally advanced right colon cancer invading pancreas and/or only duodenum. Surg Oncol 2014;23:92-8.
[11] Mackey R, Walsh RM, Chung R, Brown N, Smith A, Church J, et al. Pancreas-Sparing Duodenectomy is Effective Management for Familial Adenomatous Polyposis. J Gastrointest Surg 2005;9:1088-93, discussion 1093.
[12] Leite JS, Tralhão JG, Manso A, Fernandes M, Cunha I, Amaro P. Pancreas-and Pylorus-Preserving Duodenectomy for Advanced Familial Duodenal Polyposis. GE Port J Gastroenterol 2020;27:185-91.
[13] Naples R, Simon R, Moslim M, Augustin T, Church J, Burke CA, et al. Long-Term Outcomes of PancreasSparing Duodenectomy for Duodenal Polyposis in Familial Adenomatous Polyposis Syndrome. J Gastrointest Surg 2021;25:1233-40.
[14] Kimura Y, Mukaiya M, Honma T, Okuya K, Akizuki E, Kihara C, et al. Pancreas-sparing duodenectomy for a recurrent retroperitoneal liposarcoma: Report of a Case. Surg Today 2005;35:91-3.
[15] Cho A, Ryu M, Ochiai T. Successful Resection, Using Pancreas-Sparing Duodenectomy, of Extrahepatically Growing Hepatocellular Carcinoma Associated with Direct Duodenal Invasion. J Hepatobiliary Pancreat Surg 2002;9:393-6.
[16] Augustin T, Moslim MA, Tang A, Walsh RM. Tailored Surgical Treatment of Duodenal Polyposis in Familial Adenomatous Polyposis Syndrome. Surgery 2018;163:594-9.
[17] Acer-Demir T, Ötgün I, Özçay F. First Report of Treatment with Pancreas-Sparing Duodenectomy in a Child with Primary Intestinal Lymphangiectasia. J Indian Assoc Pediatr Surg 2020;25:106-9.
[18] Sperti C, Pasquali C, Berselli M, Frison L, Vicario G, Pedrazzoli S. Metastasis to the Pancreas from Colorectal Cancer: Is there a Place for Pancreatic Resection? Dis Colon Rectum 2009;52:1154-9.
[19] Cavallaro G, Polistena A, D’Ermo G, Pedullà G, De Toma G. Duodenal Gastrointestinal Stromal Tumors: Review on Clinical and Surgical Aspects. Int J Surg 2012;10:463-5.
[20] Papalampros A, Moris D, Petrou A, Dimitrokallis N, Karavokyros I, Schizas D, et al. Non-Whipple Operations in the Management of Benign, Premalignant and Early Cancerous Duodenal Lesions. Anticancer Res 2017;37:1443-52.