Clinical diagnosis, surgical management and prognostic factors of patients with primary duodenal carcinoma

Objective To study the diagnosis, surgical treatment and prognosis of patients with primary duodenal carcinoma. Methods The clinical data of 56 patients with primary duodenal carcinoma treated between 2008 to 2015 were retrospectively analyzed. Results The number of patients with tumors located in the first, second, third and fourth parts of duodenum were 3, 44, 6, and 3 patients respectively. Tumors which were within the papillary region accounted for 71.4% (40 patients). Twenty-two patients (22/56, 39.3%) had well differentiated adenocarcinoma, 16 patients (16/56, 28.6%) had moderately differentiated adenocarcinoma and 6 patients (7/56, 10.7%) had undifferentiated carcinoma. The clinical manifestations were not specific, which included abdominal pain, abdominal distention, jaundice, bowel obstruction or bleeding. The correct rates of diagnosis made by endoscopy, duodenography, ultrasound and CT were 84.0%, 81.3%, 30.4% and 48.2% respectively. Forty patients underwent pancreaticoduodenectomy, 5 segmental duodenectomy, 9 bypass operation, and 3 subtotal gastrectomy and duodenal bulb tumor resection. The 1-, 3-, and 5-year survival rates of all the patients were 82.6%, 56.7% and 30.1% respectively. The-1, 3-, and 5-year survival rates of the patients who underwent pancreaticoduodenectomy and segmental duodenectomy were 100%, 68.8%, 42.2% and 100%, 61.8%, 0 respectively. All the patients who underwent palliative resection died 6 to 24 months after surgery. Univariate analysis revealed the operation types, depth of tumor invasion, lymphatic invasion, and tumor differentiation correlated with prognosis. Multivariate analysis showed only the operative types, depth of tumor invasion and lymphatic invasion to be independent prognostic factors. Conclusions Tumors located in the papillary region accounted for the majority of primary malignant tumors of the duodenum and they were mainly adenocarcinomas. Duodenography and endoscopy were the major methods used in the diagnosis of primary duodenal carcinoma. Pancreaticoduodeneetomy was the best therapy for primary duodenal carcinoma. Key words: Duodenal neoplasms; Pancreaticoduodenectomy; Diagnosis; Treatment; Prognosis