A Clinicopathological Study of Our 27 Cases Undergone Resection for Primary Duodenal Adenocarcinoma

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  • 原発性十二指腸癌27切除例の臨床病理組織学的検討

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Introduction: Primary duodenal adenocarcinoma is a rare malignant gastrointestinal tract neoplasm. The unique anatomy of the duodenum makes many factors, such as treatment and surgical procedure, uncertain. Patients and Methods: We retrospectively analyzed clinical records of 27 patients who had undergone resection for primary duodenal adenocarcinoma between January 1992 and December 2007. Results: The rate of lymph node metastasis increased with tumor invasion depth. Most tumors invading beyond the serosal layer invaded the pancreas. Overall 5-year survival was 50.0%. Statistical analysis suggested that symptoms, serum CEA and CA19-9, tumor invasion depth, pancreatic invasion, and lymph node metastasis were significant prognostic factors. Discussion: Endoscopic or segmental resection is appropriate for patients whose tumor invasion depth is limited to the mucosal layer. Advanced cancer invading beyond the subserosa requires pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy with lymph node dissection in the pancreatoduodenal region, ceriac artery, and superior mesenteric artery. Rules and regulations must be determined for treating primary duodenal adenocarcinoma based on staging by numbers of lymph nodes involved in metastasis, tumor and pancreatic invasion depth, and lymph node grouping by tumor location.

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