The Surgical Treatment and Outcome for Primary Duodenal Adenocarcinoma
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The Surgical Treatment and Outcome for Primary Duodenal Adenocarcinoma Shao-liang Han & Jun Cheng & Hong-zhong Zhou & Qi-Qiang Zeng & Sheng-Hong Lan
Published online: 10 June 2009 # Humana Press Inc. 2009
Abstract Background The purpose of this study was to investigate the early diagnosis and outcomes of surgical treatment of primary duodenal adenocarcinoma (PDAC) for curative purpose. Method Thirty-two PDAC patients treated surgically between February 1990 and September 2006 were analyzed retrospectively. Results All 32 patients underwent laparotomy, including 18 patients (56.3%) pancreaticoduodenectomy (PD), six patients (18.7%) segmental resection (SR), and eight patients bypass procedures. R0 resections were obtained in 22 patients; the other 10 procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 86.2% (25/29), 48.3% (14/29), and 20.7% (6/29), respectively, moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (19/19), 73.7% (14/19), and 31.6%(6/19), 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% (5/18) in pancreaticoduodenectomy patients and 16.7% (1/6) in segmental resection patients, and there was no significant difference between the above two procedures (P>0.05). Conclusion PD is suggested for 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.
Keywords duodenal neoplasm . pancreaticoduodenectomy . survival . segmental resection
The manuscript is being submitted as original article.
Patients and Methods
S.-l. Han (*) : J. Cheng : H.-z. Zhou : Q.-Q. Zeng : S.-H. Lan Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000 Zhejiang Province, People’s Republic of China e-mail: [email protected] e-mail: [email protected]
Abbreviation PADC Primary duodenal adenocarcinoma PD Pancreaticoduodenectomy CT Computed tomography US Ultrasonography CA19-9 CA19-9 antigen ALP Alkaline phosphates FT-207 Ftorafur Introduction Primary duodenal adenocarcinomas (PDAC) are uncommon tumors characterized by nonspecific symptoms and late diagnosis [1–3]. PDACs account for just 0.3% of all gastrointestinal malignancies but represent 25% to 45% of small intestine adenocarcinoma [1–5]. This implies that the duodenum is easier to develop adenocarcinoma than the other parts of small bowel, although duodenum is only 10% of small bowel. Because of the anatomic and physiological specificity of the duodenum, the diagnosis and treatment of PDAC have some controversies [6–9]. The objective of this study was to assess the diagnosis and surgical treatment of duodenal adenocarcinoma in our department.
Patients Eligibility Thirty-two patients with PDAC were treated with surgical procedure between February 1990 and Septem-
34
ber 2006 at the Department of General Surgery, the F
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