title: Villous tumors of the duodenum.
abstract: Records of 32 patients with 34 villous and tubulovillous adenomas of the duodenum, treated at the Cleveland Clinic over the past 21 years, were reviewed. Twenty-two patients (69%) had complete resection of the adenoma; the incidence of malignancy was 47%. Five patients underwent a Whipple procedure; 4 patients had segmental resection of the duodenum; 12 had wide local excision of the adenoma; 1 had both a segmental resection and a local excision for two separate adenomas; and 5 patients had endoscopic excision alone. The remaining five patients underwent exploratory laparotomy alone or with palliative bypass procedures. A 28% recurrence rate was observed, all of these after segmental resection, local excision, or endoscopic excision. The highest recurrence rate was associated with local excision. The 2- and 5-year survival rates for patients with adenomas containing invasive cancer were 22% and 0%, respectively, compared to 87% and 87%, respectively, for benign adenomas (including those with carcinoma in situ). Twenty-two per cent of patients had intestinal polyposis syndromes. Duodenal adenomas were diagnosed a mean of 17 years after colectomy for polyposis, indicating the need for continued surveillance in these patients.
authors.affiliation: Department of General Surgery, Cleveland Clinic Foundation, OH 44106.
authors.forename: S
authors.initials: S
authors.lastname: Galandiuk
authors.forename: R E
authors.initials: RE
authors.lastname: Hermann
authors.forename: D G
authors.initials: DG
authors.lastname: Jagelman
authors.forename: V W
authors.initials: VW
authors.lastname: Fazio
authors.forename: M V
authors.initials: MV
authors.lastname: Sivak
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology / Q000601:surgery; D004379:Duodenal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000150:complications / Q000473:pathology / Q000601:surgery; D008297:Male; D008722:Methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D013997:Time Factors