Simultaneous laparoscopic subtotal colectomy and pancreaticoduodenectomy for colonic FAP and ampullary cancer.
Laparoscopic surgery has extended its applications to resection of malignancies with favorable results. We report the first successful simultaneous laparoscopic subtotal colectomy and pancreaticoduodenectomy (PD) in a patient with familial adenomatous polyposis (FAP).
A 37-year-old man presented with obstructive jaundice. Gastroscopy and biopsies revealed a large ampullary tubulovillous adenoma with mild dysplasia (Spigelman stage III). A colonoscopy for suspicion of FAP revealed numerous right-sided polyps with left-sided sparing. Computed tomography showed a double duct sign. A simultaneous laparoscopic subtotal colectomy and PD was performed successfully. The operative time was 225 minutes for the colectomy and 390 minutes for the PD. Histology showed an R0 resection of ampullary adenocarcinoma (20 negative nodes) and colonic polyps with low-grade dysplasia. Genetic screening confirmed a diagnosis of FAP.
A simultaneous laparoscopic subtotal colectomy and PD in patients with FAP and ampullary neoplasia seems safe with favorable clinical and oncologic outcomes.
The University of Manchester, The Department of Hepato-Pancreato-Biliary, North Manchester General Hospital, Manchester, UK.
SourceSurgical laparoscopy, endoscopy & percutaneous techniques 22:2 2012 Apr pg e79-82
MeSHAdenomatous Polyposis Coli
Ampulla of Vater
Common Bile Duct Neoplasms
Pub Type(s)Case Reports