Relationship between Cancer Diagnosis and Complications Following Pancreatoduodenectomy for Duodenal Adenoma

• Authors: Nina L. Eng, Emory University; Danielle E. Mustin, Emory University; Brendan P. Lovasik, Emory University; Michael K. Turgeon, Emory University; Adriana C. Gamboa, Emory University; Mihir Shah, Emory University; Kenneth Cardona, Emory University; Juan Sarmiento, Emory University; Maria Russell, Emory University; Shishir Maithel, Emory University; Jeffrey Switchenko, Emory University; David Kooby, Emory University
• Journal Title: Annals of Surgical Oncology
• Volume: Volume 28, Number 2
• Publisher: Springer | 2020-07-20, Pages 1097-1105
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1245/s10434-020-08767-1
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Oncology; Health Sciences, Health Care Management; Biology, Biostatistics
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Surgery; Postoperatic; Surgical complications; Major complications; Classification; Score; Impact

Abstract

Background: Pancreatoduodenectomy (PD) for duodenal adenoma (DA) resection may be associated with excessive surgical risk for patients with potentially benign lesions, given the absence of pancreatic duct obstruction. We examined factors associated with final malignant pathology and evaluated the postoperative course of patients with DA versus pancreatic ductal adenocarcinoma (PDAC). Methods: We retrospectively analyzed patients with DA who underwent PD from 2008 to 2018 and assessed the accuracy rate of preoperative biopsy and factors associated with final malignant pathology. Complications for DA patients were compared with those of matched PDAC patients. Results: Forty-five consecutive patients who underwent PD for DA were identified, and the preoperative biopsy false negative rate was 29. Factors associated with final malignant pathology included age over 70 years, preoperative biliary obstruction, and common bile duct diameter > 8 mm (p < 0.05). Compared with patients with PDAC (n = 302), DA patients experienced more major complications (31% vs. 15%, p < 0.01), more grade C postoperative pancreatic fistulas (9% vs. 1%, p < 0.01), and greater mortality (7% vs. 2%, p < 0.05). Propensity score matched patients with DA had more major complications following PD (32% vs. 12%, p < 0.05). Conclusions: Preoperative biopsy of duodenal adenomas is associated with a high false-negative rate for malignancy, and PD for DA is associated with higher complication rates than PD for PDAC. These results aid discussion among patients and surgeons who are considering observation versus PD for DA, especially in younger patients without biliary obstruction, who are less likely to harbor malignancy.