Diagnosis and treatment of primary duodenal tumors

Abstract

Objective To investigate the diagnosis and therapeutic methods of primary tumors of the duedenum(PTD). Methods Clinical data of 124 patients with primary duodenal tumors who were hospitalized in the First Affiliated Hospital of China Medical University from 2001 to 2007 were analyzed retrospectively. Of all the tumors,10 cases were of benign tumors and 114 cases were malignant tumors. Diagnosis was established on endoscopy and radiography. Results Common clinical manifestations included upper abdominal pain, jaundice, weight loss and poor appetite. Lesion located in the superior portion of the duodenum in 9 cases, in the descending portion in 107 cases, in the horizontal portion in 7 cases, and in the ascending portion in 1 case. The correct preoperative diagnostic rate by endoscopy was 90.5%, by ERCP was 94.1%, by ultra-endoscopy was 100%, by air barium double radiography was 78.6%, by MRI was 80.5%, and by BUS was 40.6%. Among the 10 benign PTD cases, 5 cases underwent simple tumor resection, 2 cases underwent standard pancreaticoduedenectomy, 1 case received segmental duodenectomy and 2 cases didn't receive operation, the 5-year survival rate was 100%. Among the 114 malignant PTD cases, 47 cases underwent standard pancreaticoduodenectomy, 3 cases received pylorus preserving pancreaticoduodenectomy, 3 cases underwent pancreaticeduodenectomy in other hospitals, with the 5-year survival rate of 35.8%. Six cases underwent simple tumor resection, and 12 case received segmental duodenectomy, with the 5-year survival rate of 16.7%. Twenty-two cases treated by bypass operation died in 5-16 months after operation. 2 cases treated by stent-intervention, and 2 cases by PTCD (percutancous transhepatic cholangiodrainage) died in 3-11 months. Those not treated surgically died in 1-11 months. Conclusions Patients with PTD usually lack specific clinical manifestations, but combination of endoscopy, ultra-endoscopy, ERCP and other eximinations can improve the preoperative positive diagnosis rate. simple tumor resection and segmental duodenectomy are curable for PBTDs (primary benign tumors of the duodenum), while for PMTDs (primary malignant tumors of duodenum), pancreaticoduodenectomy should be done, and bypass operation is suitable for late-stage patients to improve survival rate and life-quality. Key words: Duodenal neoplasms; Diagnosis; Surgical procedures; operative