Delayed diagnosis and lower resection rate of adenocarcinoma of the distal duodenum

Carcinoma of the duodenum is a rare disease that can present with varied symptoms and is often misdiagnosed. Prolonged survival following resection of the primary tumour is possible, whilst irresectable disease has a very poor prognosis. The factors determining resectability of the primary tumour have not been addressed.

We reviewed 45 consecutive cases of duodenal carcinoma to investigate factors which influence the operative outcome of patients with this condition.

Details of symptoms, diagnoses, surgical procedures and pathology were retrieved from patient records. There were 29 male and 16 female patients aged 24-79 years (median = 64 years).

The frequency of tumours in the proximal and distal duodenum was 27 and 18. Failure to diagnose the tumours at endoscopy occurred in 10 of 27 tumours of the proximal duodenum and 15 of 18 tumours of the distal duodenum. The duration of symptoms prior to diagnosis was correspondingly longer for tumours in the distal duodenum (20 weeks) than the proximal duodenum (12 weeks). Of 27 patients with tumours in the proximal duodenum, 18 underwent a potentially curative resection, whereas only 6 of the 18 tumours in the distal duodenum were resectable with curative intent. The reasons for irresectability of lesions in the distal duodenum included malignant lymphadenopathy affecting the small bowel mesentery in ten cases, which was not noted in any patient with adenocarcinoma of the proximal duodenum.

Our results suggest that lesions of the distal duodenum are inadequately investigated by endoscopy, and that distal duodenal tumours are less curable by resectional surgery due to invasion of the small bowel mesentery.