Pancreas-sparing duodenectomy for a huge leiomyosarcoma in the third portion of the duodenum

A duodenal leiomyosarcoma which was resected by pancreas-sparing duodenectomy is reported. The tumor arose in the third portion of the duodenum and grew in an extraluminal direction. The tumor was huge (13 cm × 9 cm × 8 cm) but did not involve the pancreas, and there were no findings of periduodenal lymph node metastases. Because the possibility of metastasis to the lymph nodes around the root of the superior mesenteric artery (which are removed only in a pancreatoduodenectomy) was judged to be low, pancreas-sparing duodenectomy was performed, with dissection of the pancreaticoduodenal lymph nodes. The proximal duodenum was transected between the second and third portions of the duodenum, and the distal end was cut in the jejunum at the portion of the first jejunal artery. Reconstruction was performed by end-to-side anastomosis between the duodenum and jejunum, using an end-to-end anastomosis instrument. Since the incidence of lymph node metastasis of leiomyosarcoma is low, resection of the head of the pancreas for extensive lymph node dissection does not always seem necessary. Pancreas-sparing duodenectomy can be a good option for a leiomyosarcoma in the third and fourth portions of the duodenum which does not invade the pancreas and is not accompanied by any apparent periduodenal lymph node metastases. Received for publication on May 1, 1997; accepted on April 21, 1999