Laparoscopic assisted pancreas preserving total duodenectomy for duodenal cancer

Abstract

Pancreas preserving total duodenectomy (PPTD) is rarely performed in patients with duodenal disease. In addition, because PPTD was performed in the past by opening the entire abdomen, case reports of laparoscopic-assisted PPTD (LAPPTD) in patients with duodenal disease are rarer still. Here, we report the case of a 64-year-old man with diabetes in whom abnormal duodenal mucosa was found on endoscopy. The lesion was located close to Vater's papilla, making endoscopic excision difficult; therefore, we planned a surgical duodenectomy. Since imaging findings indicated the lesion to be benign or a non-invasive carcinoma, and the patient had diabetes, we decided to perform PPTD. Additionally, to reduce operative stress, we opted for LAPPTD. Due to excess visceral fat, the surgical time was 11 h 10 min. He had a postoperative course without severe complications, and was followed up for 2 years 6 months, during which he had no relapse or severe complications. We consider this operative method to be admissible in cases of benign or non-invasive duodenal cancer in which pancreas preservation is desirable.