Pancreatico-duodenectomy for cancer and precancer in familial adenomatous polyposis.

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.