[Treatment of 54 cases of primary malignant duodenal tumor]

To study the treatment of primary malignant duodenal tumor.

The data of 54 cases of primary malignant duodenal tumor during 1993 approximately 2003 were analyzed retrospectively.

Clinical manifestations were jaundice, abdominalgia, obstruction of digest tract and bleeding. Correct diagnosis rates of image examination were endoscopic retrograde cholangiopancreatography 92.8%, air barium double radiography 70.8%, gastroscopy 50.0%, CT 21.9%, MRI 21.4%. Tumor location was 1 in duodenal bulb, 45 in descending portion, 3 in horizontal part and none in ascending portion. 48 malignant tumors were operated, 31 pancreaticoduodenectomy, 1 pancreaticoduodenectomy and partial resection of superior mesenteric vein, 6 radical segmental duodenal resection, 1 palliative segmental duodenal resection, 3 duodenal wedge resection, 5 bypass operation (gastrojejunostomy and/or cholangiojejunostomy), 1 jejunostomy. Adjuvant chemotherapy was given in 13 cases. The survival rates were 5-year 45.4%, 3-year 45.4%, 1-year 63.2%. Median survival months were 24, 10, 38 and 16 respectively for radical operation group, palliative operation group, with postoperative adjuvant therapy group and without postoperative adjuvant therapy group. No significant survival time was found between radical operation group and palliative operation group, adjuvant therapy group and without postoperative adjuvant therapy group, pancreaticoduodenectomy group and radical segmental duodenal resection group in statistics. Among lymphyaden metastasis, tumor size, tumor depth, tumor thrombi, pathologic type and operative methods, only tumor thrombi had prognostic significance in multivariate analysis.

Pancreaticoduodenectomy and radical segmental duodenal resection should be selected for primary malignant duodenal tumor. Bypass operation can prolong survival and improve life-quality. Postoperative adjuvant treatment is advocated.