A Clinicopathological Study of Our 27 Cases Undergone Resection for Primary Duodenal Adenocarcinoma

Satoshi Inose, Yoshiaki Tsuchiya, Tatsuya Nomura, Atsushi Nashimoto, Yasumasa Takii, Hiroshi Yabusaki, Satoru Nakagawa, Otsuo Tanaka and Tamaki Ohta*

Department of Surgery and Department of Pathology*, Niigata Cancer Center Hospital

Introduction: Primary duodenal adenocarcinoma is a rare malignant gastrointestinal tract neoplasm. The unique anatomy of the duodenum makes many factors, such as treatment and surgical procedure, uncertain. Patients and Methods: We retrospectively analyzed clinical records of 27 patients who had undergone resection for primary duodenal adenocarcinoma between January 1992 and December 2007. Results: The rate of lymph node metastasis increased with tumor invasion depth. Most tumors invading beyond the serosal layer invaded the pancreas. Overall 5-year survival was 50.0%. Statistical analysis suggested that symptoms, serum CEA and CA19-9, tumor invasion depth, pancreatic invasion, and lymph node metastasis were significant prognostic factors. Discussion: Endoscopic or segmental resection is appropriate for patients whose tumor invasion depth is limited to the mucosal layer. Advanced cancer invading beyond the subserosa requires pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy with lymph node dissection in the pancreatoduodenal region, ceriac artery, and superior mesenteric artery. Rules and regulations must be determined for treating primary duodenal adenocarcinoma based on staging by numbers of lymph nodes involved in metastasis, tumor and pancreatic invasion depth, and lymph node grouping by tumor location.

Key words
primary duodenal adenocarcinoma, pancreaticoduodenectomy, prognostic factor, pancreatic invasion

Reprint requests
Satoshi Inose Department of Surgery, Nagareyama Central Hospital
2-132-2 Higashihatsuishi, Nagareyama, 270-0114 JAPAN

Accepted
June 18, 2009

To read the PDF file you will need Abobe Reader installed on your computer.