Limited (pancreas-sparing) surgical resections for non-ampullary duodenal neoplasms: indications, surgical techniques and outcomes

: Non-ampullary duodenal neoplasms (DNs) are rare, heterogeneous lesions for which the optimal surgical strategy remains debated. While pancreatoduodenectomy (PD) is considered the standard for ampullary or locally advanced tumours, limited resection (LR) of the duodenum offers a pancreas-preserving alternative in appropriately selected cases. This study aimed to describe the indications, surgical techniques, and outcomes of LR for non-ampullary DNs. All consecutive patients undergoing LR, including segmental resection (SR), wedge resection (WR), extra-mucosal excision (EME), endoluminal excision (ELE), for non-ampullary DNs at our institution between August 2010 and May 2025 were retrospectively reviewed. Demographic, operative, pathological, and follow-up data were collected from a prospectively maintained database. Disease-specific survival (DSS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method, with subgroup analyses for duodenal adenocarcinoma (DA), gastrointestinal stromal tumors (GIST), and neuroendocrine tumors (NET). Thirty-three patients underwent LR: SR D1 (n = 2, 6.1%), SR D3-D4 (n = 13, 39.4%), WR (n = 13, 39.4%), EME (n = 2, 6.1%), and ELE (n = 3, 9.1%). Median operative time was 219 min (IQR 162-278) and median blood loss was 100 mL (IQR 50-100). Overall morbidity occurred in 45.4% of patients, with severe complications in 18.2% and no 90-day mortality. Final histology included GIST/leiomyoma (45.4%), DA (18.2%), NET (18.2%), and adenoma (18.2%). At a median follow-up of 66.8 months for DA, 75.6 months for GIST, and 61.4 months for NET, 5-year DSS/DFS rates were 80%/66.7% for DA, with only one recurrence in the GIST group and two recurrences in the NET group (one disease-related death). LR of the duodenum is a safe and effective alternative to PD for selected non-ampullary DNs, with low morbidity, no perioperative mortality, and excellent long-term oncological outcomes in appropriately chosen patients. When technically feasible and without ampullary or pancreatic invasion, LR should be considered the preferred approach for localized duodenal GIST, selected D3-D4 DA, and non-ampullary NET requiring surgery.