[Adenocarcinoma of the duodenum. 17 cases]

Seventeen cases of duodenal adenocarcinoma are reported and compared with cases from the literature. Ten tumours were located in the second part of the duodenum, 9 were around the hepatopancreatic ampulla, 4 were above and 4 below this ampulla. Four tumours (23 per cent) had limited intramural expansion (Dukes' stage A or B) and 6 (35 per cent) involved the lymph nodes. The major clinical signs were loss of weight (11 cases), signs of obstruction (9 cases), bleeding (6 cases) and jaundice (6 cases). The paraclinical examinations that were determinant for the diagnosis were gastroduodenal radiographic study (16 cases) and endoscopy with biopsy (9 cases). Computerized tomography was useful for preoperative evaluation. The respective values of these examinations for early diagnosis and excisability of these tumors are discussed. All 17 patients were operated upon: 11 (64.7 per cent) underwent radical excision, 5 had duodenal bypass and 1 had exploratory laparotomy. The overall operative mortality rate was 5.8 per cent, with no deaths for bypasses and excisions. Mean survival after bypass was 5 1/2 months. The one year survival was 63.5 per cent in 5 patients with excision and 83.3 per cent in 6 patients with cephalic duodenopancreatectomy, but none of these patients survived for more than 5 years.