Segmental Duodenal Resections: Toward Defining Indications, Complexity, and Coding.

Autor: Patel DD; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA. devanshipatelmd@gmail.com., Abdulkarim AB; Department of Surgery, Veterans Administration Hospital, Memphis, TN, USA.; Department of Surgery, Baptist Memorial Medical Education, 6025 Walnut Grove Road, Suite 207, Memphis, TN, 38120, USA., Behrman SW; Department of Surgery, Baptist Memorial Medical Education, 6025 Walnut Grove Road, Suite 207, Memphis, TN, 38120, USA. stephen.behrman@baptist.edu.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2023 Nov; Vol. 27 (11), pp. 2373-2379. Date of Electronic Publication: 2023 Sep 25.
DOI: 10.1007/s11605-023-05837-z
Abstrakt: Background: Segmental resections of the duodenum are uncommonly performed and are technically challenging due to intimate relationships with the biliary tree, pancreas, and superior mesenteric vessels. The objective of this study was to assess indications, operative strategy, and outcomes of duodenal resections and to advocate that this form of resection deserves its own unique Current Procedural Terminology (CPT) and Relative Value Unit (RVU) structure.
Methods: Patients undergoing isolated and partial duodenal resection from 2008-2023 at University of Tennessee Health Science Center affiliated hospitals were retrospectively reviewed. Factors examined included clinical presentation, diagnostic evaluation, operative time, and technique, 90-day morbidity and mortality, and pathologic and survival outcomes.
Results: Thirty-one patients were identified with majority female and a median age of 61. Diagnostic studies included computed tomography and upper (including push) endoscopy. Reconstruction most often involved side-to-side duodenojejunostomy following distal duodenal resection. Intraoperative evaluation (IOE) of the biliary tree was utilized to assess and protect pancreaticobiliary structures in eleven patients. Median operative time was 206 min, increasing to 236 min when IOE was necessary. Procedure-related morbidity was 23% with one 90-day mortality. Median postoperative length of stay was 9 days. Pathology included benign adenoma, adenocarcinoma, GIST, neuroendocrine neoplasms, and erosive metastatic deposit.
Conclusion: Duodenal resections can be effectively employed to safely address diverse pathologies. These procedures are characterized by long operative times, extended hospital stays, and an incidence of postoperative complications that mimics that of pancreatic resection. This work highlights the need for modification to the CPT system to accurately define these distinct procedures for future research endeavors and development of a more accurate valuation unit.
(© 2023. The Society for Surgery of the Alimentary Tract.)
Databáze: MEDLINE
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