title: Adenocarcinoma of the third duodenal portion: Case report and review of literature.
abstract: We focus on the diagnostic and therapeutic problems of duodenal adenocarcinoma, reporting a case and reviewing the literature. A 65-year old man with adenocarcinoma in the third duodenal portion was successfully treated with a segmental resection of the third part of the duodenum, avoiding a duodeno-cephalo-pancreatectomy. This tumor is very rare and frequently affects the III and IV duodenal portion. A precocious diagnosis and the exact localization of this neoplasia are crucial factors in order to decide the surgical strategy. Given a non-specificity of symptoms, endoscopy with biopsy is the diagnostic gold standard. Duodeno-cephalo-pancreatectomy (DCP) and segmental resection of the duodenum (SRD) are the two surgical options, with overlapping morbidity (27% vs 18%) and post operative mortality (3% vs 1%). The average incidence of postoperative long-term survival is 100%, 73.3% and 31.6% of cases after 1, 3 and 5 years from surgery, respectively. Long-term survival is made worse by two factors: the presence of metastatic lymph nodes and tumor localization in the proximal duodenum. The two surgical options are radical: DCP should be used only for proximal localizations while SRD should be chosen for distal localizations.
authors.affiliation: Federico Sista, Giuseppe De Santis, Antonio Giuliani, Emanuela Marina Cecilia, Federica Piccione, Laura Lancione, Sergio Leardi, Gianfranco Amicucci, General Surgery, Department of Surgery, University of L'Aquila, 67100 L'Aquila, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Sista
authors.forename: Giuseppe De
authors.initials: GD
authors.lastname: Santis
authors.forename: Antonio
authors.initials: A
authors.lastname: Giuliani
authors.forename: Emanuela Marina
authors.initials: EM
authors.lastname: Cecilia
authors.forename: Federica
authors.initials: F
authors.lastname: Piccione
authors.forename: Laura
authors.initials: L
authors.lastname: Lancione
authors.forename: Sergio
authors.initials: S
authors.lastname: Leardi
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Amicucci