Pancreas sparing duodenectomy in the treatment of primary duodenal neoplasms and other situations with duodenal involvement

Background:There are no clearly defined indications for pancreas-preserving duodenectomy.The present study aimed to analyze postoperative morbidity and the outcomes of patients undergoing pancreaspreserving duodenectomy.Methods:Patients undergoing pancreas-preserving duodenectomy from April 2008 to May 2020 were included.We divided the series according to indication:scenario 1,primary duodenal tumors;scenario 2,tumors of another origin with duodenal involvement;and scenario 3,emergency duodenectomy.Results:We included 35 patients.Total duodenectomy was performed in 1 patient of adenomatous duodenal polyposis,limited duodenectomy in 7,and third+fourth duodenal portion resection in 27.The indications for scenario 1 were gastrointestinal stromal tumor(n=13),adenocarcinoma(n=4),neuroendocrine tumor(n=3),duodenal adenoma(n=1),and adenomatous duodenal polyposis(n=1);scenario 2:retroperitoneal desmoid tumor(n=2),recurrence of liposarcoma(n=2),retroperitoneal paraganglioma(n=1),neuroendocrine tumor in pancreatic uncinate process(n=1),and duodenal infiltration due to metastatic adenopathies of a germinal tumor with digestive hemorrhage(n=1);and scenario 3:aortoenteric fistula(n=3),duodenal trauma(n=1),erosive duodenitis(n=1),and biliopancreatic limb ischemia(n=1).Severe complications(Clavien-Dindo≥IIIb)developed in 14%(5/35),and postoperative mortality was 3%(1/35).Conclusions:Pancreas-preserving duodenectomy is useful in the management of primary duodenal tumors,and is a technical option for some tumors with duodenal infiltration or in emergency interventions.

Robot-Assisted Nephrotomy as a Nephron-Sparing Approach for Completely Intraparenchymal Renal Tumors

Introduction: The diagnosis of small renal masses and the endophytic tumor approach have become challenging. This study aims to describe exclusively robot-assisted surgery as an alternative nephron-sparing approach for renal intraparenchymal tumors. Patients and Methods: We retrospectively analyzed all patients with completely endophytic tumors undergoing robot-assisted partial nephrectomy, treated under the Da Vinci System®, aided by intraoperative ultrasound. The patients’ demographic characteristics, perioperative and oncological outcomes were assessed. Results: From a total of 13 partial nephrectomies performed between 06/2010 and 10/2021, all patients underwent nephrotomy. The patients’ mean age was 52 years and the tumor measured mean 2.6 cm. Warm ischemia time was 24 minutes and histopathological analysis revealed that 12 patients had renal cell carcinoma. In a mean 36-month follow-up, no significant renal function alterations were found and no local or systemic recurrences occurred. Conclusion: Robot-assisted access is a safe and effective option for the nephron-sparing technique in completely intraparenchymal renal tumors.