Q) What is the Surgery in FAP patient after colectomy for ampullary adenoma Stage IV
a)Classic Whipple b) Pancreas preserving duodenectomy c) Transduodenal excision d) endoscopic excision
Answer is free for all
b)
Duodenal cancers are the third most common (10%) cause of death in FAP after CRC and desmoid disease.
Duodenal adenomas 100% incidence
tendency to progress to cancer.
The severity of duodenal adenomatosis predicts the chances of duodenal cancer, Spigelman staging system that is based on
adenoma number, size, and histology
Patients with stage 0 disease (no adenomas) can be surveyed again in 5 years.
Stage I patients can be surveyed in 3 years;
stage II in 1 year;
stage III in 6 months
and stage IV is an indication to consider surgery. 36 % progress to cancer- Surgery is pancreas preserving duodenectomy
A Whipple is indicated for a duodenal cancer that is definitively operable
Duodenal adenomas can be treated by snare polypectomy or by transduodenal polypectomy. Ampullary adenomas can be treated by endoscopic mucosal resection or surgical ampullectomy
