The diagnosis and treatment primary malignant tumor of the duodenum:a report of 54 cases / 中国普通外科杂志

ABSTRACT

Objective To investigate improvements in the diagnosis and treatment of primary malignant tumor of the duodenum. Methods The clinical data of 54 patients with primary malignant tumor of the duodenum treated during a period of 6 years were analysed retrospectively. Results Tumors located in the first, second, third and fourth parts accounted for 6 cases(11.1%), 44 cases(81.5%), 2 cases(3.7%), and 2 cases(3.7%) respectively; and among them, ampullary tumor accounted for 38 cases(86.4%) of tumor of descending portion of duodenum and 70.4% of the total number of duodenal tumors. The main clinical presentation included jaundice, upper abdominal pain, weight loss, abdominal distention, and gastrointestinal obstruction. Upper abdominal pain, no positive signs and abdominal mass were found in 72.0%, 20.0% and 8.0% respectively on abdominal examination. Preoperative associated cholecystopathy accounted for 37.0%. The accuracy rate of duodenoscopy and ERCP in preoperative diagnosis was 94.4%, and 77.8% respectively. Preoperative diagnostic accuracy rate was 27.8%. Panceaticoduodenectomy was performed in 38 cases, duodenectonmy in 1 case, palliative resection of tumor in 9 cases, and tumor was inoperable in 6 cases. Radical resection rate was 72.2%. The postoperative 3- and 5-year survival rate was 40.6% and 21.9%, respectively. After palliative resection, death occurred from 1month to 24months. Conclusions The tumors in the ampullary region account for the majority of primary malignant tumors of the duodenum and are mainly adenocarcinoma. The symptoms of advanced stage are complicated, and specific signs on abdominal examination are few. Associated cholecystopathy is relatively ferquent and preoperative accurate diagnostic rate is low. The examinations of first choice are duodenoscopy and ERCP, and radical panceaticoduodenectomy can extend survival time.