Surgical treatment of primary duodenal adenocarcinoma.
OBJECTIVE
Our purpose was to review the outcome of the patients with primary duodenal adenocarcinoma and determine factors influencing survival.


METHODS
Over a 10-year period, 43 patients with this disease were identified. Data were analyzed to assess the outcomes of treatment and predictors of survival.


RESULTS
Patients had symptoms present for an average of 6 months. The most common symptom was obstructive jaundice, observed in 55.8% of the cases. Based on symptomology, primary duodenal adenocarcinoma may be classified into three categories: icteric, obstructive and illusive. The upper gastrointestinal contrast study and esophagogastroduodenoscopy were the most effective diagnostic tests, showing an accuracy of 79.5% and 86.8%, respectively. A curative resection was performed in 28 of the 43 patients (65.1%), a conventional pancreatoduodenectomy in 11, segmental duodenal resection in 16 and gastroduodenectomy in 1. The overall 5-year survival rate was 27%, which was 42 percent after curative resection.


CONCLUSIONS
The respectability of the primary lesion was associated with increased survival. An aggressive surgical approach should be pursued. Pancreaticoduodenectomy is usually required for tumors of the first and second portion of the duodenum. Segmental resection may be appropriate for selected patients, especially for cancers of the distal duodenum.
Hu
Ji-Xiong
JX
Department of General Surgery, the Second Affiliated Hospital, XiangYa Medical College Central South University, ChangSha, P.R. China. hujixiong@medmail.com.cn
Miao
Xiong-Ying
XY
Zhong
De-Wu
DW
Dai
Wei-Dong
WD
Liu
Wei
W
Hu
Wei
W
D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D004379:Duodenal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D016896:Treatment Outcome