The surgical treatment and outcome for primary duodenal adenocarcinoma.

BACKGROUND

Primary duodenal adenocarcinomas (PDAC) are uncommon tumors characterized by non-specific symptoms and late diagnosis, and treatments of PDAC have some controversies.

METHOD

To investigate the early diagnosis and outcomes of surgical treatment of PDAC, 32 patients who were treated surgically between February 1990 and September 2006 were analyzed retrospectively.

RESULTS

All 32 patients underwent laparotomy, including 18 patients (56.3%) with pancreaticoduodenectomy (PD), six patients (18.7%) with segmental resection (SR), and eight patients with bypass procedures. And, R0 resections were obtained in 22 patients; the other ten procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 86.2% (25 of 29), 48.3% (14 of 29), and 20.7% (six of 29), respectively. Moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (19 of 19), 73.7% (14 of 19), and 31.6% (six of 19), which were significantly higher than those (50.0% = 5/10, 0% and 0%) in patients with palliative operation (P < 0.05), respectively. Furthermore, the 5-year survival rate was 27.8% (five of 18) in pancreaticoduodenectomy patients and 16.7% (one of six) in segmental resection patients, and there was no significant difference between the above two procedures (P > 0.05).

CONCLUSION

PD is suggested for the tumor located at the first and second portion of the duodenum, and SR may be appropriate for the selected patients, especially for tumors of the distal duodenum.