Duodenal villous tumors.
The treatment of 36 patients with duodenal villous tumors was reviewed to determine the long-term outcome of various surgical treatment options for specific adenoma histopathology. Duodenal villous tumors were typically solitary and periampullary in location. Villous adenomas contained epithelial atypia in 30% of patients, in situ carcinoma in 14%, and invasive carcinoma in 33%. Treatment consisted of transduodenal submucosal excision in 19 patients and radical pancreaticoduodenectomy in 15. There was no perioperative mortality. Perioperative morbidity for transduodenal excision and pancreaticoduodenectomy was 16% and 47%, respectively. Benign adenomas recurred more than 5 years postoperatively in 17% of patients undergoing transduodenal excision. Five-year survival following radical resection for invasive cancers was 45%. Overall median follow-up was 5.8 years. We conclude that duodenal villous tumors without invasive cancer can be managed successfully by local submucosal excision, but invasive carcinoma requires radical resection.
Bjork
K J
KJ
Department of Surgery, Mayo Clinic, Rochester, Minn. 55905.
Davis
C J
CJ
Nagorney
D M
DM
Mucha
P
P
D000236:Adenoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004379:Duodenal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004384:Duodenoscopy; D004386:Duodenum / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy; D012189:Retrospective Studies; D015996:Survival Rate