ArticleSurgical endoscopy2026
Operative management of primary duodenal masses: is a limited resection actually safer?
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
backgroundThe operative management of duodenal tumors remains controversial with outcomes comparing pancreatoduodenectomy (PD) versus duodenectomy arising from small, noncontemporary cohorts. The aim of this study is to examine perioperative outcomes between PD and duodenectomy for duodenal masses. It is hypothesized that the morbidity profile of a duodenectomy lies between that of a PD and that of an enterectomy for a distal small bowel tumor.
methodsA single-institution retrospective review was performed of patients with non-ampullary duodenal tumors who underwent PD or duodenectomy between 2006 and 2025. Duodenectomy was classified as proximal (D1/D2) versus distal (D3/D4) duodenectomy based on tumor location. Patients who underwent enterectomy for jejunal/ileal tumors were identified as another comparison group. The primary outcome was 30-day major morbidity, defined as a composite of core complications (delayed oral feeding autonomy, abscess, anastomotic leak, bleeding requiring intervention, reoperation) and was evaluated across four cohorts: PD vs. proximal duodenectomy vs. distal duodenectomy vs. enterectomy.
resultsThe analytic cohort consisted of 235 patients: PD = 86 (36.6%), proximal duodenectomy = 39 (16.6%), distal duodenectomy = 45 (19.1%), enterectomy = 65 (27.7%). Among patients who underwent duodenectomy, 23 (27.4%) underwent a local excision, and 61 (72.6%) underwent a segmental resection. 76 (32.3%) patients suffered major morbidity. Major morbidity rates were the following: PD = 47.7% vs. proximal duodenectomy = 30.8% vs. distal duodenectomy = 35.6% vs. enterectomy = 10.8% (p < 0.001). Adjusting for covariates, proximal [OR: 3.76, 95% CI: (1.21, 11.7), p = 0.022] and distal [OR: 3.77, 95% CI: (1.44, 9.87), p = 0.007] duodenectomy were associated with a higher likelihood of morbidity relative to enterectomy.
conclusionsDuodenectomy for duodenal masses may be performed for select non-ampullary tumors and is associated with a considerable profile that is higher than that of enterectomy for distal small bowel tumors. Therefore, duodenectomy merits consideration as a distinct procedural service.
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