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Duodenal Adenomas in Familial Adenomatous Polyposis

  • Andrew LatchfordEmail author
  • Brian Saunders
Chapter
Part of the M.D. Anderson Solid Tumor Oncology Series book series (MDA, volume 5)

Abstract

Duodenal disease is becoming an increasingly important cause of morbidity and mortality in patients with FAP. Our current understanding of these lesions is poor and the reason for the lower malignant potential of duodenal polyps compared to colonic polyps in FAP is unexplained. In this chapter we review our current understanding of duodenal disease in FAP, its epidemiology, aetiology and natural history. We describe the sparse evidence regarding the management of these lesions and provide our recommendations for surveillance and management.

Keywords

FAP Duodenum Ampulla Adenoma Cancer Surveillance Treatment 

References

  1. 1.
    Hauser G. Uber polyposis intestinalis adenomatosa und deren Beziehungen zur Krebsentwicklung. Duetsche Arc Klim Med. 1895;55:429–48.Google Scholar
  2. 2.
    Jagelman DG, DeCosse JJ, Bussey HJR, Group LCP. Upper gastrointestinal cancer in familial adenomatous polyposis. Lancet. 1988;1:1149–51.PubMedCrossRefGoogle Scholar
  3. 3.
    Spigelman AD, Williams CB, Talbot IC, Domizio P, Phillips RKS. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet. 1989;2:783–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Offerhaus GJ, Giardiello FM, Krush AJ, Booker SV, Tersmette AC, Kelley NC, et al. The risk of upper gastrointestinal cancer in familial adenomatous polyposis. Gastroenterology. 1992;102(6):1980–2 [see comments].PubMedGoogle Scholar
  5. 5.
    Arvanitis ML, Jagelman DG, Fazio VW, Lavery IC, McGannon E. Mortality in patients with familial adenomatous polyposis. Dis Colon Rectum. 1990;33(8):639–42.PubMedCrossRefGoogle Scholar
  6. 6.
    Bulow S, Alm T, Fausa O, Hultcrantz R, Jarvinen H, Vasen H. Duodenal adenomatosis in familial adenomatous polyposis. DAF Project Group. Int J Colorectal Dis. 1995;10(1):43–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Belchetz LA, Berk T, Bapat BV, Cohen Z, Gallinger S. Changing causes of mortality in patients with familial adenomatous polyposis. Dis Colon Rectum. 1996;39(4):384–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Tonelli F, Nardi F, Bechi P, Taddei G, Gozzo P, Romagnoli P. Extracolonic polyps in familial polyposis coli and Gardner’s syndrome. Dis Colon Rectum. 1985;28(9):664–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Sarre RG, Frost AG, Jagelman DG, Petras RE, Sivak MV, McGannon E. Gastric and duodenal polyps in familial adenomatous polyposis: a prospective study of the nature and prevalence of upper gastrointestinal polyps. Gut. 1987;28(3):306–14.PubMedCrossRefGoogle Scholar
  10. 10.
    Iida M, Yao T, Itoh H, Watanabe H, Matsui T, Iwashita A, et al. Natural history of duodenal lesions in Japanese patients with familial adenomatosis coli (Gardner’s syndrome). Gastroenterology. 1989;96(5 Pt 1):1301–6.PubMedGoogle Scholar
  11. 11.
    Domizio P, Talbot IC, Spigelman AD, Williams CB, Phillips RK. Upper gastrointestinal pathology in familial adenomatous polyposis: results from a prospective study of 102 patients. J Clin Pathol. 1990;43(9):738–43.PubMedCrossRefGoogle Scholar
  12. 12.
    Bulow S, Bjork J, Christensen IJ, Fausa O, Jarvinen H, Moesgaard F, et al. Duodenal adenomatosis in familial adenomatous polyposis. Gut. 2004;53(3):381–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Nugent KP, Spigelman AD, Phillips RK. Life expectancy after colectomy and ileorectal anastomosis for familial adenomatous polyposis. Dis Colon Rectum. 1993;36(11):1059–62.PubMedCrossRefGoogle Scholar
  14. 14.
    Bertario L, Presciuttini S, Sala P, Rossetti C, Pietroiusti M. Causes of death and postsurgical survival in familial adenomatous polyposis: results from the Italian Registry. Italian Registry of Familial Polyposis Writing Committee. Semin Surg Oncol. 1994;10(3):225–34.PubMedCrossRefGoogle Scholar
  15. 15.
    Vasen HF, Bulow S, Myrhoj T, Mathus-Vliegen L, Griffioen G, Buskens E, et al. Decision analysis in the management of duodenal adenomatosis in familial adenomatous polyposis. Gut. 1997;40(6):716–9 [see comments].PubMedCrossRefGoogle Scholar
  16. 16.
    Bjork J, Akerbrant H, Iselius L, Bergman A, Engwall Y, Wahlstrom J, et al. Periampullary adenomas and adenocarcinomas in familial adenomatous polyposis: cumulative risks and APC gene mutations. Gastroenterology. 2001;121(5):1127–35.PubMedCrossRefGoogle Scholar
  17. 17.
    Burke CA, Beck GJ, Church JM, van Stolk RU. The natural history of untreated duodenal and ampullary adenomas in patients with familial adenomatous polyposis followed in an endoscopic surveillance program. Gastrointest Endosc. 1999;49(3 Pt 1):358–64.PubMedCrossRefGoogle Scholar
  18. 18.
    Spigelman AD, Crofton-Sleigh C, Venitt S, Phillips RK. Mutagenicity of bile and duodenal adenomas in familial adenomatous polyposis. Br J Surg. 1990;77(8):878–81.PubMedCrossRefGoogle Scholar
  19. 19.
    Spigelman AD, Owen RW, Hill MJ, Phillips RK. Biliary bile acid profiles in familial adenomatous polyposis. Br J Surg. 1991;78(3):321–5 [see comments].PubMedCrossRefGoogle Scholar
  20. 20.
    Spigelman AD, Scates DK, Venitt S, Phillips RKS. DNA adducts, detected by 32P-post labelling, in the foregut of patinets with familial adenomatous polyposis and in unaffected controls. Carcinogenesis. 1991;12:1727–32.PubMedCrossRefGoogle Scholar
  21. 21.
    Scates DK, Spigelman AD, Phillips RK, Venitt S. DNA adducts detected by 32P-postlabelling, in the intestine of rats given bile from patients with familial adenomatous polyposis and from unaffected controls. Carcinogenesis. 1992;13(4):731–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Scates DK, Spigelman AD, Nugent KP, Phillips RK, Venitt S. DNA adducts, detected by 32P-postlabelling, in DNA treated in vitro with bile from patients with familial adenomatous polyposis and from unaffected controls. Carcinogenesis. 1993;14(6):1107–10.PubMedCrossRefGoogle Scholar
  23. 23.
    Mahmoud NN, Dannenberg AJ, Bilinski RT, Mestre JR, Chadburn A, Churchill M, et al. Administration of an unconjugated bile acid increases duodenal tumors in a murine model of familial adenomatous polyposis. Carcinogenesis. 1999;20(2):299–303.PubMedCrossRefGoogle Scholar
  24. 24.
    Sanabria JR, Croxford R, Berk TC, Cohen Z, Bapat BV, Gallinger S. Familial segregation in the occurrence and severity of periampullary neoplasms in familial adenomatous polyposis. Am J Surg. 1996;171(1):136–40. discussion 140–1.PubMedCrossRefGoogle Scholar
  25. 25.
    Leggett BA, Young JP, Biden K, Buttenshaw RL, Knight N, Cowen AE. Severe upper gastrointestinal polyposis associated with sparse colonic polyposis in a familial adenomatous polyposis family with an APC mutation at codon 1520. Gut. 1997;41(4):518–21.PubMedCrossRefGoogle Scholar
  26. 26.
    Bertario L, Russo A, Sala P, et al. Hereditary colorectal tumour registry. Multiple approach to the exploration of the genotype–phenotype correlations in FAP. J Clin Oncol. 2003;21:1698–797.PubMedCrossRefGoogle Scholar
  27. 27.
    Groves C, Lamlum H, Crabtree M, Williamson J, Taylor C, Bass S, et al. Mutation cluster region, association between germline and somatic mutations and genotype–phenotype correlation in upper gastrointestinal familial adenomatous polyposis. Am J Pathol. 2002;160(6):2055–61.PubMedCrossRefGoogle Scholar
  28. 28.
    Beroud C, Soussi T. APC gene: database of germline and somatic mutations in human tumors and cell lines. Nucleic Acids Res. 1996;24(1):121–4.PubMedCrossRefGoogle Scholar
  29. 29.
    Campbell-Thompson M, Lauwers GY, Reyher KK, Cromwell J, Shiverick KT. 17Beta-estradiol modulates gastroduodenal preneoplastic alterations in rats exposed to the carcinogen N-methyl-N′-nitro-nitrosoguanidine. Endocrinology. 1999;140(10):4886–94.PubMedCrossRefGoogle Scholar
  30. 30.
    Campbell-Thompson M. Estrogen receptor alpha and beta expression in rat upper gastrointestinal tract with regulation of trefoil family factor 2mRNA levels in ovariectomised rats. Biochem Biophy Res Commun. 1997;240:247–518.CrossRefGoogle Scholar
  31. 31.
    Salih M, Sims SH, Kalu DN. Putative intestinal estrogen receptor: evidence for regional differences. Mol Cell Endocrinol. 1996;121:47–55.PubMedCrossRefGoogle Scholar
  32. 32.
    Suraweera N, Haines J, McCart A, Rogers P, Latchford A, Coster M, et al. Genetic determinants modulate susceptibility to pregnancy-associated tumourigenesis in a recombinant line of Min mice. Hum Mol Genet. 2006;15(23):3429–35.PubMedCrossRefGoogle Scholar
  33. 33.
    Spigelman AD, Talbot IC, Penna C, Nugent KP, Phillips RK, Costello C, et al. Evidence for adenoma–carcinoma sequence in the duodenum of patients with familial adenomatous polyposis. The Leeds Castle Polyposis Group (Upper Gastrointestinal Committee). J Clin Pathol. 1994;47(8):709–10.PubMedCrossRefGoogle Scholar
  34. 34.
    Toyooka M, Konishi M, Kikuchi-Yanoshita R, Iwama T, Miyaki M. Somatic mutations of the adenomatous polyposis coli gene in gastroduodenal tumors from patients with familial adenomatous polyposis. Cancer Res. 1995;55(14):3165–70.PubMedGoogle Scholar
  35. 35.
    Gallinger S, Vivona AA, Odze RD, Mitri A, O’Beirne CP, Berk TC, et al. Somatic APC and K-ras codon 12 mutations in periampullary adenomas and carcinomas from familial adenomatous polyposis patients. Oncogene. 1995;10(9):1875–8.PubMedGoogle Scholar
  36. 36.
    Lamlum H, Ilyas M, Rowan A, Clark S, Johnson V, Bell J, et al. The type of somatic mutation at APC in familial adenomatous polyposis is determined by the site of the germline mutation: a new facet to Knudson’s ‘two-hit’ hypothesis. Nat Med. 1999;5(9):1071–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Latchford A, Volikos E, Johnson V, et al. APC mutations in FAP-associated desmoid tumours are non-random but not “just right”. Hum Mol Genet. 2007;16(1):78–82.PubMedCrossRefGoogle Scholar
  38. 38.
    Kashiwagi H, Spigelman AD, Talbot IC, Debinski HS, McKie AB, Lemoine NR, et al. p53 and K-ras status in duodenal adenomas in familial adenomatous polyposis. Br J Surg. 1997;84(6):826–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Achille A, Scupoli MT, Magalini AR, Zamboni G, Romanelli MG, Orlandini S, et al. APC gene mutations and allelic losses in sporadic ampullary tumours: evidence of genetic difference from tumours associated with familial adenomatous polyposis. Int J Cancer. 1996;68(3):305–12.PubMedCrossRefGoogle Scholar
  40. 40.
    Kashiwagi H, Spigelman AD, Talbot IC, Phillips RK. Overexpression of p53 in duodenal tumours in patients with familial adenomatous polyposis. Br J Surg. 1996;83(2):225–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Takaku K, Oshima M, Miyoshi H, et al. Intestinal tumourigenesis in compound mutatnt mice of both Dpc4 (Smad4) and Apc genes. Cell. 1998;92:645–56.PubMedCrossRefGoogle Scholar
  42. 42.
    McCarthy D, Hruban R, Argani P, et al. Role of the DPC4 tumour suppressor gene in adenocarcinoma of the ampulla of Vater: analysis of 140 cases. Mod Pathol. 2003;16:272–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Brosens L, Iacobuzio-Donahue C, Keller J, et al. Increased COX-2 expression in duodenal compared with colonic tissue in familial adenomatosis polyposis and relationship to the −765G C COX-2 polymorphism. Clin Cancer Res. 2005;11(11):4090–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Resnick M, Gallinger S, Wang H, et al. Growth factor expression and proliferation kinetics in periampullary neoplasms in familial adenomatosis polyposis. Cancer. 1995;76:187–94.PubMedCrossRefGoogle Scholar
  45. 45.
    Mizumoto I, Ogawa Y, Niiyama H, et al. Possible role of telomerase activation in the multistep tumour progresssion of periampullary lesions in patients with familial adenomatosis polyposis. Am J Gastroenterol. 2001;96(4):1261–5.PubMedCrossRefGoogle Scholar
  46. 46.
    Groves CJ, Saunders BP, Spigelman AD, Phillips RK. Duodenal cancer in patients with familial adenomatous polyposis (FAP): results of a 10 year prospective study. Gut. 2002;50(5):636–41.PubMedCrossRefGoogle Scholar
  47. 47.
    Chan C, Herrera M, Garza L, et al. Clinical behaviour and prognostic factors of periampullary adenocarcinoma. Ann Surg. 1995;222:632–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Sarmiento J, Nagorney D, Sarr M, Farnell M. Periampullary cancers: are there differences? Surg Clin North Am. 2001;81:543–55.PubMedCrossRefGoogle Scholar
  49. 49.
    Kashiwagi H, Spigelman AD, Debinski HS, Talbot IC, Phillips RK. Surveillance of ampullary adenomas in familial adenomatous polyposis. Lancet. 1993;344(8936):1582 [letter].CrossRefGoogle Scholar
  50. 50.
    Latchford A, Neale K, Phillips R, Clark S. A single center experience of duodenal cancer in FAP. Abstract. Yokohama: International Society for Gastrointestinal Hereditary Tumours; 2007.Google Scholar
  51. 51.
    de Vos tot Nederveen Cappel W, Jarvinen H, Bjork J, et al. Worldwide survey among polyposis registries of surgical management of severe duodenal adenomatosis in familial adenomatous polyposis. Br J Surg. 2003;90:705–10.CrossRefGoogle Scholar
  52. 52.
    Gallagher M, Shankar A, Groves C, et al. Pylorus-preserving pancreaticoduodenectomy for advanced duodenal disease in familial adenomatous polyposis. Br J Surg. 2004;91:1157–64.PubMedCrossRefGoogle Scholar
  53. 53.
    Nugent KP, Spigelman AD, Williams CB, Talbot IC, Phillips RK. Surveillance of duodenal polyps in familial adenomatous polyposis: progress report. J R Soc Med. 1994;87(11):704–6.PubMedGoogle Scholar
  54. 54.
    Nugent KP, Farmer KCR, Spigelman AD, Williams CB, Phillips RKS. Randomized controlled trial of the effect of sulindac on duodenal and rectal polyposis and cell proliferation in patients with familial adenomatous polyposis. Br J Surg. 1993;80(12):1618–9.PubMedCrossRefGoogle Scholar
  55. 55.
    Giardello FM, Hamilton SR, Krush AJ, Piantadosi S, Hylind LM, Celano P, et al. Treatment of colonic and rectal adenomas with sulindac in familial adenomatous polyposis. N Engl J Med. 1993;328(18):1313–6.CrossRefGoogle Scholar
  56. 56.
    Steinbach G, Lynch PM, Phillips RK, Wallace MH, Hawk E, Gordon GB, et al. The effect of celecoxib, a cyclooxygenase-2 inhibitor, in familial adenomatous polyposis. N Engl J Med. 2000;342(26):1946–52.PubMedCrossRefGoogle Scholar
  57. 57.
    Seow-Choen F, Vijayan V, Keng V. Prospective randomized study of sulindac versus calcium and calciferol for upper gastrointestinal polyps in familial adenomatous polyposis. Br J Surg. 1996;83(12):1763–6.PubMedCrossRefGoogle Scholar
  58. 58.
    Richard CS, Berk T, Bapat BV, Haber G, Cohen Z, Gallinger S. Sulindac for periampullary polyps in FAP patients. Int J Colorectal Dis. 1997;12(1):14–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Winde G, Schmid KW, Brandt B, Muller O, Osswald H. Clinical and genomic influence of sulindac on rectal mucosa in familial adenomatous polyposis. Dis Colon Rectum. 1997;40(10):1156–68. discussion: 1168–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Maclean A, McLeod R, Berk T, et al. A randomised trial comparing ursodeoxycholic acid and rofecoxib, a selective COX-2 inhibitor, in the treatment of advanced duodenal adenomas in patients with familial adenomatous polyposis. Gastroenterology. 2001;120 Suppl 1:A-254.Google Scholar
  61. 61.
    Phillips RK, Wallace MH, Lynch PM, Hawk E, Gordon GB, Saunders BP, et al. A randomised, double blind, placebo controlled study of celecoxib, a selective cyclooxygenase 2 inhibitor, on duodenal polyposis in familial adenomatous polyposis. Gut. 2002;50(6):857–60.PubMedCrossRefGoogle Scholar
  62. 62.
    Fries S, Grosser T, Price T, et al. Marked interindividual variability in the response to selective inhibitors of cyclooxygenase-2. Gastroenterology. 2006;130(1):55–64.PubMedCrossRefGoogle Scholar
  63. 63.
    Halushka M, Walker L, Halushka P. Genetic variation in cyclooxygenase 1: effects on response to aspirin. Clin Pharmacol Ther. 2003;73(1):122–30.PubMedCrossRefGoogle Scholar
  64. 64.
    Scates D, Venitt S, Phillips R, Spigelman A. High pH reduces DNA damage caused by bile from patients with familial adenomatous polyposis: antacids may attenuate duodenal polyposis. Gut. 1995;36(6):918–21.PubMedCrossRefGoogle Scholar
  65. 65.
    Wallace MH, Forbes A, Beveridge IG, Spigelman AD, Hewer A, Venitt S, et al. Randomized, placebo-controlled trial of gastric acid-lowering therapy on duodenal polyposis and relative adduct labeling in familial adenomatous polyposis. Dis Colon Rectum. 2001;44(11):1585–9.PubMedCrossRefGoogle Scholar
  66. 66.
    Jacoby RF, Cole CE, Tutsch K, Newton MA, Kelloff G, Hawk ET, et al. Chemopreventive efficacy of combined piroxicam and difluoromethylornithine treatment of Apc mutant Min mouse adenomas, and selective toxicity against Apc mutant embryos. Cancer Res. 2000;60(7):1864–70.PubMedGoogle Scholar
  67. 67.
    Cruz-Correa M, Shoskes D, Sanchez P, et al. Combination treatment with curcumin and quercetin of adenomas in familial adenomatous polyposis. Clin Gastroenterol Hepatol. 2006;4(8):1035–8.PubMedCrossRefGoogle Scholar
  68. 68.
    Penna C, Phillips RK, Tiret E, Spigelman AD. Surgical polypectomy of duodenal adenomas in familial adenomatous polyposis: experience of two European centres. Br J Surg. 1993;80(8):1027–9.PubMedCrossRefGoogle Scholar
  69. 69.
    Penna C, Bataille N, Balladur P, et al. Surgical treatmnet of severe duodenal polyposis in familial adenomatous polyposis. Br J Surg. 1998;85(5):665–8.PubMedCrossRefGoogle Scholar
  70. 70.
    Heiskanen I, Kellokumpu I, Jarvinen H. Management of duodenal adenomas in 98 patients with familial adenomatous polyposis. Endoscopy. 1999;31(6):412–6.PubMedCrossRefGoogle Scholar
  71. 71.
    Soravia C, Berk T, Haber G, et al. Management of advanced duodenal polyposis in familial adenomatous polyposis. J Gastrointest Surg. 1997;1(5):474–8.PubMedCrossRefGoogle Scholar
  72. 72.
    Ouaissi M, Panis Y, Sielezneff I, et al. Long-term outcome after ampullectomy for ampullary lesions associated with familial adenomatous polyposis. Dis Colon Rectum. 2005;5:187–95.Google Scholar
  73. 73.
    Mackey R, Walsh M, Chung R, et al. Pancreas-sparing duodenectomy is effective management for familial adenomatous polyposis. J Gastrointest Surg. 2005;9(8):1088–93.PubMedCrossRefGoogle Scholar
  74. 74.
    Latchford A, Gallagher M, Neale K, Phillips R. A review of endoscopic follow up of postoperative duodenal adenomas in FAP. Familial Cancer. 2005;4 Suppl 1:P75.Google Scholar
  75. 75.
    Murakami Y, Uemura K, Sasaki M, et al. Duodenal cancer arising from the remaining duodenum after pylorus-preserving pancreatoduodenectomy for ampullary cancer in familial adenomatous polyposis. J Gastrointest Surg. 2005;9(3):389–92.PubMedCrossRefGoogle Scholar
  76. 76.
    Norton ID, Geller A, Petersen BT, Sorbi D, Gostout CJ. Endoscopic surveillance and ablative therapy for periampullary adenomas. Am J Gastroenterol. 2001;96(1):101–6.PubMedCrossRefGoogle Scholar
  77. 77.
    Catalano M, Linder J, Chak A, et al. Endoscopic management of adenoma of the major duodenal papilla. Gastrointest Endosc. 2004;59(2):225–32.PubMedCrossRefGoogle Scholar
  78. 78.
    Latchford A, Gallagher M, Newton D, et al. Endoscopic therapy for duodenal adenomas in familial adenomatous polyposis. Yokohama: International Society for Gastrointestinal Hereditary Tumours; 2007.Google Scholar
  79. 79.
    Mlkvy P, Messmann H, Debinski H, Regula J, Conio M, MacRobert A, et al. Photodynamic therapy for polyps in familial adenomatous polyposis – a pilot study. Eur J Cancer. 1995;31A(7–8):1160–5.PubMedGoogle Scholar
  80. 80.
    Regula J, MacRobert A, Gorchevin A, et al. Photosensitisation and photodynamic therapy of oesophageal, duodenal and colorectal tumours using 5 aminolavulinic acid induced protoporphyrin IX – a pilot study. Gut. 1995;36:67–75.PubMedCrossRefGoogle Scholar
  81. 81.
    Nugent KP, Spigelman AD, Williams CB, Phillips RK. Iatrogenic pancreatitis in familial adenomatous polyposis. Gut. 1993;34(9):1269–70.PubMedCrossRefGoogle Scholar
  82. 82.
    Marpugo E, Vitale G, Galandiuk S, et al. Clinical characteristics of familial adenomatous polyposis and management of duodenal adenomas. J Gastrointest Surg. 2004;8:559–64.CrossRefGoogle Scholar
  83. 83.
    Alarcon FJ, Burke CA, Church JM, van Stolk RU, Williams CS, Mann M, et al. Familial adenomatous polyposis – efficacy of endoscopic and surgical treatment for advanced duodenal adenomas. The role of cyclooxygenases in inflammation, cancer, and development. Dis Colon Rectum. 1999;42(12):1533–6.PubMedCrossRefGoogle Scholar
  84. 84.
    Penna C, Bataille N, Balladur P, Tiret E, Parc R. Surgical treatment of severe duodenal polyposis in familial adenomatous polyposis. Br J Surg. 1998;85(5):665–8.PubMedCrossRefGoogle Scholar
  85. 85.
    Ruo L, Coit DG, Brennan MF, Guillem JG. Long-term follow-up of patients with familial adenomatous polyposis undergoing pancreaticoduodenal surgery. J Gastrointest Surg. 2002;6(5):671–5.PubMedCrossRefGoogle Scholar
  86. 86.
    Chung RS, Church JM, van Stolk R. Pancreas-sparing duodenectomy: indications, surgical technique, and results. Surgery. 1995;117(3):254–9.PubMedCrossRefGoogle Scholar
  87. 87.
    Kalady MF, Clary BM, Tyler DS, Pappas TN. Pancreas-preserving duodenectomy in the management of duodenal familial adenomatous polyposis. J Gastrointest Surg. 2002;6(1):82–7.PubMedCrossRefGoogle Scholar
  88. 88.
    Balladur P, Penna C, Tiret E, Vaillant JC, Gailleton R, Parc R. Pancreatico-duodenectomy for cancer and precancer in familial adenomatous polyposis. Int J Colorectal Dis. 1993;8(3):151–3.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Derriford HospitalPlymouthUK

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