title: Duodenojejunal flexure tumors: surgical difficulties with case series.
abstract: BACKGROUND
  Distal duodenal and duodenojejunal flexure tumors are rare. They present late due to vague symptomatology and difficulties in establishing a diagnosis. Due to vague symptoms, these tumors would have had spread locally or metastasized to regional nodes or distant organs at presentation. Though the present standard is to achieve R0 resection for any tumor, it is quite difficult in these tumors because of their proximity to many important named vessels and viscera. Role of neoadjuvant and adjuvant therapy is not established yet.
  
  
  METHODS
  Medical records of patients searched who were admitted and diagnosed to have duodenal tumors between January, 2011 and March, 2014. Patients with duodenal tumors arising from third or fourth part were analysed. Radiological, endoscopic findings were noted and compared with operative and histopathological report.
  
  
  RESULTS
  Nine patients (seven males and two females) were found to have tumor in the third and fourth part of the duodenum. All had undergone laparotomy with curative intention in eight patients. R0 resection was feasible only in five (55%) patients. The most common histopathological type is adenocarcinoma in 66% patients.
  
  
  CONCLUSIONS
  Segmental resection is feasible and may be curative in most of the patients with duodenojejunal flexure tumors, without the need for vascular resections and reconstructions. Adenocarcinomas are the most common variant. Lymph node involvement and microvascular invasion indicates poor prognosis.
authors.affiliation: 1 Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, India ; 2 Department of General Surgery, Calcutta National Medical College Kolkata, India ; 3 Centre for liver diseases and transplantation, Apollo Hospitals, Chennai, India.
authors.forename: Addala Pavan
authors.initials: AP
authors.lastname: Kumar
authors.affiliation: 1 Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, India ; 2 Department of General Surgery, Calcutta National Medical College Kolkata, India ; 3 Centre for liver diseases and transplantation, Apollo Hospitals, Chennai, India.
authors.forename: Sudeepta K
authors.initials: SK
authors.lastname: Swain
authors.affiliation: 1 Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, India ; 2 Department of General Surgery, Calcutta National Medical College Kolkata, India ; 3 Centre for liver diseases and transplantation, Apollo Hospitals, Chennai, India.
authors.forename: Somak
authors.initials: S
authors.lastname: Das
authors.affiliation: 1 Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, India ; 2 Department of General Surgery, Calcutta National Medical College Kolkata, India ; 3 Centre for liver diseases and transplantation, Apollo Hospitals, Chennai, India.
authors.forename: Souvik
authors.initials: S
authors.lastname: Paul
authors.affiliation: 1 Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, India ; 2 Department of General Surgery, Calcutta National Medical College Kolkata, India ; 3 Centre for liver diseases and transplantation, Apollo Hospitals, Chennai, India.
authors.forename: Kirubakaran
authors.initials: K
authors.lastname: Renganathan
authors.affiliation: 1 Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, India ; 2 Department of General Surgery, Calcutta National Medical College Kolkata, India ; 3 Centre for liver diseases and transplantation, Apollo Hospitals, Chennai, India.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Zirpe
authors.affiliation: 1 Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, India ; 2 Department of General Surgery, Calcutta National Medical College Kolkata, India ; 3 Centre for liver diseases and transplantation, Apollo Hospitals, Chennai, India.
authors.forename: Gopa
authors.initials: G
authors.lastname: Kumar
authors.affiliation: 1 Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, India ; 2 Department of General Surgery, Calcutta National Medical College Kolkata, India ; 3 Centre for liver diseases and transplantation, Apollo Hospitals, Chennai, India.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Gopasety
authors.affiliation: 1 Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, India ; 2 Department of General Surgery, Calcutta National Medical College Kolkata, India ; 3 Centre for liver diseases and transplantation, Apollo Hospitals, Chennai, India.
authors.forename: Patta
authors.initials: P
authors.lastname: Radhakrishna
authors.affiliation: 1 Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, India ; 2 Department of General Surgery, Calcutta National Medical College Kolkata, India ; 3 Centre for liver diseases and transplantation, Apollo Hospitals, Chennai, India.
authors.forename: Tirupporur Govindaswamy
authors.initials: TG
authors.lastname: Balachandar
keywords: Distal duodenal tumors; duodenojejunal junction; ligament of Trietz; small intestinal tumors