Primary adenocarcinoma of the duodenum: treatment and survival in 89 patients

Primary adenocarcinoma of the duodenum is a rare disease and diagnosis is always late in being confirmed because of the non-specific symptoms, consequently leading to poor prognosis.

A retrospective review of 89 patients with non-ampullary duodenal adenocarcinoma treated in 36 different surgical departments in Italy between 1980 and 1994 was performed. The signs and symptoms, diagnostic studies conducted, tumor locations, surgical treatment, and survival were analyzed.

Duodenography and endoscopy were the most effective diagnostic tests, showing an accuracy of 81.9% and 88%, respectively. The most common tumor site was periampullary, observed in 62.9% of the cases. A curative resection was performed in 65 of the 89 patients (73%), a partial pancreatoduodenectomy in 37, a segmentary duodenal resection in 15 and a wide local excision in 11. The postoperative mortality rate was 10.1% (9 patients), and the overall 5-year survival was 25%, which was significantly better after resection. The most important prognostic factors were stage and tumor location.

Early diagnosis of primary duodenal adenocarcinoma is the only way to improve the results, by providing a higher resectability rate.