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. 2011 May;13(5):342-9.
doi: 10.1111/j.1477-2574.2011.00292.x. Epub 2011 Mar 10.

Pancreaticoduodenectomy for advanced duodenal and ampullary adenomatosis in familial adenomatous polyposis

James R A Skipworth  1 , Clare Morkane, Dimitri Aristotle Raptis, Soumil Vyas, Steven W Olde Damink, Charles J Imber, Stephen P Pereira, Massimo Malago, Nicholas West, Robin K S Phillips, Sue K Clark, Arjun Shankar
Affiliations

Pancreaticoduodenectomy for advanced duodenal and ampullary adenomatosis in familial adenomatous polyposis

James R A Skipworth et al. HPB (Oxford). 2011 May.

Abstract

Background: Patients with familial adenomatous polyposis (FAP) develop duodenal and ampullary polyps that may progress to malignancy via the adenoma-carcinoma sequence.

Objective: The aim of this study was to review a large series of FAP patients undergoing pancreaticoduodenectomy for advanced duodenal and ampullary polyposis.

Methods: A retrospective case notes review of all FAP patients undergoing pancreaticoduodenectomy for advanced duodenal and ampullary adenomatosis was performed.

Results: Between October 1993 and January 2010, 38 FAP patients underwent pancreaticoduodenectomy for advanced duodenal and ampullary polyps. Complications occurred in 29 patients and perioperative mortality in two. Postoperative histology revealed five patients to have preoperatively undetected cancer (R = 0.518, P < 0.001).

Conclusions: Pancreaticoduodenectomy in FAP is associated with significant morbidity, but low mortality. All patients under consideration for operative intervention require careful preoperative counselling and optimization.

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Figures

Figure 1
Figure 1
Analysis of preoperative and operative staging showed five patients to have preoperatively undetected cancer (four duodenal and one ampullary; Pearson's kappa correlation coefficient: 0.518 [P < 0.001])
Figure 2
Figure 2
Longterm follow-up of 38 familial adenomatous polyposis patients undergoing resection for advanced duodenal and ampullary adenomatosis illustrates a shorter, overall 5-year survival in patients with postoperative histology demonstrating frank malignancy compared with those with Spigelman stage III or IV disease (62.5% vs. 81.6%; P = 0.325)
Figure 3
Figure 3
All-cause mortality in 38 familial adenomatous polyposis patients undergoing resection for advanced duodenal and ampullary adenomatosis
Figure 4
Figure 4
Postoperative complications in 38 familial adenomatous polyposis patients undergoing pancreaticoduodenectomy for advanced duodenal and ampullary adenomatosis
Figure 5
Figure 5
Analysis of highest-grade complication per patient, as defined by Clavien–Dindo grade, in 38 familial adenomatous polyposis patients undergoing resection for advanced duodenal and ampullary adenomatosis
See this image and copyright information in PMC

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