[Adenocarcinoma of the duodenum. Contribution to the study of a rare pathology]

Primary adenocarcinoma of the duodenum is a rare lesion and represents 0.35% of all tumors of the gastrointestinal tract. 75% of the primary tumors of the duodenum are adenocarcinomas and 33-45% of the adenocarcinomas of the small bowel arise in the duodenum. The incidence of these tumors has been estimated to be 0.03%. The diagnosis is usually made at a very late stage because the symptoms are often non-specific. The mean diagnostic delay between beginning of symptoms and the diagnosis is of 10 months. Oesogastroduodenoscopy is the diagnostic procedure of choice and upper GI series is still of interest since it permits a topographic analysis of the lesion. Pancreatico-duodenectomy is recognized by a majority of authors as the standard curative procedure, in the absence of regional nodes. Survival after pancreaticoduodenectomy in the absence of local lymph node invasion is 68% at 5 years whereas there is no survivor after 3 years when there is regional invasion of the lymph nodes. Survival rates after palliative excisions are generally of 15 months, after bilio-digestive derivation of 6 months. Radical excision is preferable in as much as it is technically feasible.