Villous tumors of the duodenum: a retrospective study of 47 cases by the French Associations for Surgical Research.

BACKGROUND

We evaluated villous tumors of the duodenum in regard to preoperative diagnosis of malignancy and the choice of treatment.

STUDY DESIGN

From January 1974 to October 1992, forty-seven patients with a benign or malignant tumor arising from the duodenal mucosa were studied. Forty-two patients underwent a macroscopically complete resection of the tumor. Nineteen tumors were malignant.

RESULTS

Preoperative endoscopic biopsy results had a 52 percent sensitivity and 100 percent specificity for the diagnosis of malignancy. For the 42 patients who underwent complete resection, jaundice was predictive of malignancy (p < 0.01), whereas tumor size was not (p < 0.2). The five-year survival rate of this group was 69.5 percent (confidence interval: 50 to 84). The recurrence rate was higher (p < 0.01) and the survival rate shorter (p < 0.001) for patients who underwent ampullectomy (n = 8) compared with patients treated by limited resection (n = 20) or pancreatoduodenectomy (n = 14).

CONCLUSIONS

Preoperative diagnosis of malignancy is difficult for villous tumors of the duodenum. For tumors located near the papilla, it seems that pancreatoduodenectomy is the best treatment.