Abstract
Duodenal adenomas occur in most patients with familial adenomatous polyposis and their potential for malignant transformation appears to be high. In case of rapid polyp growth or severe dysplasia, the place of surgical resection is controversial. We report 2 patients with familial adenomatous polyposis who underwent radical pancreatico duodenectomy several years after the treatment of colonic polyposis. The first patient had a pancreaticoduodenal resection performed for a duodenal adenocarcinoma. The second patient had a pancreaticoduodenal resection with pylorus preservation and pancreatogastric anastomosis performed for recurrent duodenal adenomas with severe dysplasia. Both remained alive without recurrence and with a good functional outcome 24 and 28 months after operation. We conclude that radical prophylactic surgery may be indicated for patients with familial adenomatous polyposis who have severe duodenal polyposis.
Résumé
Les adénomes duodénaux surviennent chez de nombreux patients avec polypose adenomateuse familiale et leur potentiel de transformation maligne semble être haut. En cas de croissance rapide du polype ou de dysplasie sévère la place de la résection chirurgicale est controversée. Nous rapportons deux patients avec une polypose adénomateuse familiale qui ont subi une duodénopancréatectomie radicale plusieurs années après le traitement de leur polypose colique. Le premier patient a eu une résection duodénopancréatique réalisée pour un adénocarcinome duodénal. Le deuxième malade a eu une résection duodénopancréatique avec conservation pylorique et anastomose pancréatogastrique réalisée pour un adénome duodénal récidivant avec dysplasie sévère. Les deux malades demeurent vivants sans récidive et avec un bon résultat fonctionnel 24 et 28 mois après l'opération. Nous concluons que la chirurgie radicale prophylactique peut être indiquée chez les patients avec polypose adénomateuse familiale qui ont une polypose duodénale sévère.
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Balladur, P., Penna, C., Tiret, E. et al. Pancreatico-duodenectomy for cancer and precancer in familial adenomatous polyposis. Int J Colorect Dis 8, 151–153 (1993). https://doi.org/10.1007/BF00341189
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DOI: https://doi.org/10.1007/BF00341189