Limited Resection in Duodenal Malignancy: A single Center Experience

Background: Pancreas-sparing duodenectomy [PSD] has come a long way since its conception in 1990s. Since then, less than 200 cases have been published.Aim of the study: This study designed to share the outcomes of 3 Lynch Syndrome [LS], 2 gastrointestinal stromal tumors [GIST], and 1 case of duodenojejunal adenocarcinoma, who had successful PSD, aiming to highlight the efficacy and safety of this challenging operation.Patients and Methods: This case series included 6 patients with duodenal neoplasms who underwent PSD from 2022-2024. After obtaining patient’s consent, their clinical and histopathological data was reviewed retrospectively using hospital records. Details like patient demographic, location of the tumor, past surgical history, associated syndrome, and surgical resection were obtained. All patients had biopsy specimens to prove GIST or adenocarcinoma. Patients with associated syndromes had specimens validated with immunohistochemistry. Selective duodenal resection was performed after excluding the involvement of the pancreatic head and other major vessels. The outcomes and complications were recorded.Results: The mean age of the patients was 57.6 ± 9.6 years with a range of 45-69 years, and the female: male ratio was 1:5. The most common presentation was weight loss [66.6%, n=4], followed by obstruction [33%, n=2]. Three cases were associated with Lynch Syndrome. According to the tumor location, two cases were D3, two cases were DJ, one case was D2, and one case was D4. In terms of the histopathological investigation, four cases were adenocarcinoma, and two cases were GIST. All patients underwent doudeno -jejunostomy with Wide local excision in one case.Conclusion: Pancreatic Sparing Duodenectomy is safe technique for the management of cases with duodenal adenocarcinoma, and the long term surveillance will add more evidence to the literature on how to better approach and manage cases with Lynch Syndrome following Pancreatic Sparing duodenectomy.