Page 25 - JCTR-9-5

Journal of Clinical and Translational Research 2023; 9(5): 327-331

Journal of Clinical and Translational Research

Journal homepage: http://www.jctres.com/en/home

CASE REPORT

Pancreas sparing duodenal resection in colorectal adenocarcinoma with

local invasion to the duodenum: a case report and literature review

Si Ying Adelina Ho , Thomas Zheng Jie Teng *, Vishal G. Shelat 1,2
1,2
1
1 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Department of General Surgery, Tan Tock Seng Hospital,
2
Singapore
ARTICLE INFO ABSTRACT

Article history: Background: Pancreas sparing duodenal resection (PSDR) is commonly described in patients with
Received: December 21, 2022 familial duodenal adenomatous polyposis, duodenal gastrointestinal stromal tumors, duodenal trauma,
Revised: July 11, 2023 or other primary duodenal lesions where the pancreas is not involved. PSDR in patients with metastatic
Accepted: July 11, 2023 involvement of the duodenum is rarely described. After reviewing the relevant literature, <5 PSDR for
Published Online: September 23, 2023 duodenal metastases reports were retrieved. Our patient was treated with PSDR for a local recurrence
after a right hemicolectomy was performed for right colon adenocarcinoma a year before.
Keywords: Aim: The aim of the study was to investigate if PSDR is feasible in this patient with recurrence of a
Colorectal adenocarcinoma locally advanced right colon adenocarcinoma invading the duodenum.
Duodenal metastases Case Summary: A 74-year-old female patient presented with the right iliac fossa pain and weight loss
Pancreatic sparing duodenal resection 1-year post-resection of the primary ascending colon cancer. A surveillance computed tomography
Case study scan of the thorax, abdomen, and pelvis showed a mass in the third segment of the duodenum. The
decision to carry out a PSDR was made.
*Corresponding authors Results: The proximal and distal margins of the resected bowel were uninvolved by the invasive
Thomas Zheng Jie Teng carcinoma and metastasis in five out of 12 regional lymph nodes was found. The post-operative course
Tan Tock Seng Hospital, 11 Jalan Tan Tock was complicated by a Grade B post-operative pancreatic fistula but recovered well post-drainage.
Seng, 308433 Singapore. Conclusions: PSDR can be utilized in the management of duodenal metastases.
E‐mail: zteng004@e.ntu.edu.sg Relevance for Patients: PSDR can be performed in patients with duodenal metastases, offering a
lower morbidity rate as compared to conventional pancreaticoduodenectomy.
© 2023 Author(s). This is an Open-Access
article distributed under the terms of the
Creative Commons Attribution-Noncommercial
License, permitting all non-commercial use, 1. Introduction
distribution, and reproduction in any medium,
provided the original work is properly cited. The pancreas is an unforgiving organ, and surgery involving the pancreas carries a
significant risk of morbidity, especially for post-operative pancreatic fistulas (POPF). The
incidence of POPF following distal pancreatectomy or pancreaticoduodenectomy is reported
in up to 30% of patients [1]. Surgeons resort to centralizing pancreatic surgical services,
technical modification of key surgical steps, standardized protocol-driven clinical care, and
pharmacological intervention to reduce the morbidity following pancreatic resections [1,2].
One method of reducing morbidity would be to avoid pancreatic resections in, for example,
duodenal-only lesions. This is especially relevant as POPF rates following pancreas
resection are higher in patients with a soft pancreas texture and non-dilated pancreatic ducts,
a typical feature of duodenal-only lesions [3,4]. Thus, pancreas-sparing duodenal resection
(PSDR) is an attractive option, and it is no surprise that it is widely reported in patients with
familial duodenal adenomatous polyposis, duodenal gastrointestinal stromal tumors, and a
myriad of other primary duodenal lesions. Preserving the pancreas keeps the endocrine and
exocrine function intact with a low risk of post-pancreatectomy diabetes and alleviates the

DOI: http://dx.doi.org/10.18053/jctres.09.202305.22-00228