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Adenocarcinoma of the third duodenal portion: Case report and review of literature

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Author(s): Federico Sista | Giuseppe De Santis | Antonio Giuliani | Emanuela Marina Cecilia | Federica Piccione | Laura Lancione | Sergio Leardi | Gianfranco Amicucci

Journal: World Journal of Gastrointestinal Surgery
ISSN 1948-9366

Volume: 4;
Issue: 1;
Start page: 23;
Date: 2012;
Original page

Keywords: Duodenal carcinoma | Duodeno-cephalo-pancreatectomy | Segmental resection | Survival | III duodenal portion | Duodenal embryological development

ABSTRACT
We focus on the diagnostic and therapeutic problems of duodenal adenocarcinoma, reporting a case and reviewing the literature. A 65-year old man with adenocarcinoma in the third duodenal portion was successfully treated with a segmental resection of the third part of the duodenum, avoiding a duodeno-cephalo-pancreatectomy. This tumor is very rare and frequently affects the III and IV duodenal portion. A precocious diagnosis and the exact localization of this neoplasia are crucial factors in order to decide the surgical strategy. Given a non-specificity of symptoms, endoscopy with biopsy is the diagnostic gold standard. Duodeno-cephalo-pancreatectomy (DCP) and segmental resection of the duodenum (SRD) are the two surgical options, with overlapping morbidity (27% vs 18%) and post operative mortality (3% vs 1%). The average incidence of postoperative long-term survival is 100%, 73.3% and 31.6% of cases after 1, 3 and 5 years from surgery, respectively. Long-term survival is made worse by two factors: the presence of metastatic lymph nodes and tumor localization in the proximal duodenum. The two surgical options are radical: DCP should be used only for proximal localizations while SRD should be chosen for distal localizations.
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