摘要
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.
We focus on the diagnostic and therapeutic problemsof 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 Ⅳduodenal 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-ceph-alo-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% and31.6% 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
