Abstract
Background: Because of the rarity of primary adenocarcinoma of the duodenum, accumulation of natural history data has been difficult. As a result, debate continues over important treatment issues.
Methods: We did a retrospective review of 67 patients with nonampullary adenocarcinoma of the duodenum treated at the University of Texas M. D. Anderson Cancer Center between 1967 and 1991. Presenting symptoms and signs, diagnostic studies, operation performed, surgical pathology, and survival were analyzed.
Results: A primary duodenal tumor was demonstrated by upper gastrointestinal radiographs (UGI) in 37 of 42 patients (88%), esophagogastroduodenoscopy (EGD) in 49 of 55 (89%), and computerized tomograms (CT) in 21 of 42 (50%). A curative resection was performed in 36 of the 59 patients who underwent operation (61%); 27 had pancreaticoduodenectomies and nine had wide local excisions. Overall 5-year survival was 29%. The 5-year survival difference between resected and unresected patients was 54% versus 0%, respectively (p<0.0001). No survival difference was noted between patients who underwent pancreaticoduodenectomy rather than wide local excision. Lymph node metastases were significantly related to the occurrence of distant metastases (p=0.0034). The 5-year survival for patients with stage I or II tumors was 100% and 52%, respectively, compared to 45% and 0% for stage III and IV (p<0.0001).
Conclusions: Our data suggest that UGI and EGD are effective for diagnosing duodenal carcinoma. Survival is improved by curative resection and is not compromised by a wide local excision instead of a pancreaticoduodenectomy for lesions of the third and fourth portion. We recommend that adjuvant chemotherapy be considered for stage III disease, because distant failure is the predominant pattern of failure in this group.
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References
Sarma DP, Weilbaecher TG. Adenocarcinoma of the duodenum.J Surg Oncol 1987;34:262–3.
Spira IA, Ghazi A, Wolff WI. Primary adenocarcinoma of the duodenum.Cancer 1977;39:1721–6.
Gonzalez GD, Evans EC. Primary adenocarcinoma of the duodenum.Am Surg 1987;53:174–9.
Lillemoe K, Imbembo AL. Malignant neoplasms of the duodenum.Surg Gynecol Obstet 1980;150:822–6.
Joesting DR, Beart RW, van Heerden JA, Weiland LH. Improving survival in adenocarcinoma of the duodenum.Am J Surg 1981;141:228–31.
VanOoijen B, Kalsbeek HL. Carcinoma of the duodenum.Surg Gynecol Obstet 1988;166:343–7.
Alwmark A, Andersson A, Lasson A. Primary carcinoma of the duodenum.Ann Surg 1980;191:13–8.
Ouriel K, Adams JT. Adenocarcinoma of the small intestine.Am J Surg 1984;147:66–71.
Lai ECS, Doty JE, Irving C, Tompkins RK. Primary adenocarcinoma of the duodenum: analysis of survival.World J Surg 1988;12:695–9.
Moss WM, McCart PM, Juler G, Miller DR. Primary adenocarcinoma of the duodenum.Arch Surg 1974;108:805–7.
Cortese AF, Cornell GN. Carcinoma of the duodenum.Cancer 1972;29:1010–5.
Laufer I, Mullers JE, Mamilton J. The diagnostic accuracy of barium studies of the stomach and duodenum: correlation with endoscopy.Radiology 1975;115:569–73.
Burt RW, Rikkers LF, Gardner EJ, Lee RG, Tolman KG. Villous adenoma of the duodenal papilla presenting as necrotizing pancreatitis in a patient with Gardner's syndrome.Gastroenterology 1987;92:532–5.
Halvorsen RA, Thompson WM. Primary neoplasms of the hollow organs of the gastrointestinal tract.Cancer 1991;67:1181–8.
Lowell JA, Rossi RL, Munson JL, Braasch JW. Primary adenocarcinoma of the third and fourth portions of the duodenum: favorable prognosis after resection.Arch Surg 1992;127:557–60.
Skandalakis JE, Skandalakis LJ, Colborn GL, Pemberton LB, Gray SW. The duodenum: surgical anatomy.Am Surg 1989;55:291–8.
Crist DW, Sitzmann JV, Cameron JL. Improved hospital morbidity, mortality, and survival after the Whipple procedure.Ann Surg 1987;206:358–65.
Grace PA, Pitt HA, Tompkins RK, DenBesten L, Longmire WP. Decreased morbidity and mortality after pancreaticoduodenectomy.Am J Surg 1986;151:141–9.
Cameron JL, Crist DW, Sitzmann JV, et al. Factors influencing survival after pancreaticoduodenectomy for pancreatic cancer.Am J Surg 1991;161:120–5.
Willett CG, Tepper JE, Cohen AM, Orlow E, Welch CE. Failure patterns following curative resection of colonic carcinoma.Ann Surg 1984;200:685–90.
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Barnes, G., Romero, L., Hess, K.R. et al. Primary adenocarcinoma of the duodenum: Management and survival in 67 patients. Annals of Surgical Oncology 1, 73–78 (1994). https://doi.org/10.1007/BF02303544
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DOI: https://doi.org/10.1007/BF02303544